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