Manpower and Outpatient Clinic Workload for Remote Monitoring of Patients with Cardiac Implantable Electronic Devices: Data from the HomeGuide Registry

Authors


  • Funds for this research were provided by Biotronik Italia, an affiliate of Biotronik SE & Co. KG (Berlin, Germany), although Biotronik was not the sponsor of the study.

  • R.P. Ricci received minor consultancy fees from Medtronic and Biotronik. L. Morichelli received minor consultancy fees from Medtronic. N. Rovai and A. Gargaro are employees of Biotronik Italia. Other authors: No disclosures.

  • Trial registration: NCT01459874

Manpower of Cardiac Device Home Monitoring

Background

This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SE & Co. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice.

Methods

The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP.

Results

A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10–31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6–2.0) minutes, corresponding to a manpower of 43.3 (4.2–94.8) minutes/month every 100 patients for nurses and 10.2 (0.1–31.1) for physicians (P < 0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8–16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events.

Conclusions

HM implemented in the HomeGuide workflow model required <1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.

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