Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-07
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • br Mega cohort studies Remote monitoring collects a wealth o

    2019-04-25


    Mega-cohort studies Remote monitoring collects a wealth of data from large numbers of patients which are not subject to saturation or overwritten memory counters within any implantable device. These databases provide an opportunity to better understand system function, patient condition, and disease progression in “real-world” subjects, as opposed to more narrowly defined enrollees in relatively short term trials. Long-term parameter trends derived from these databases will provide important measures of system performance, e.g., generator and lead survival. Automatically archived data will also permit accurate follow-up of patient morbidities. For example, AF is difficult to characterize in practice, but remote monitoring permits clinicians to interpret arrhythmia patterns, absolute AF burden, degree of temporal dispersion, and progression to persistent arrhythmia. These factors may help clinicians to understand the risks this condition poses and to optimize its management. These questions are being addressed, in particular by the ALTITUDE committee [45].
    Persistent challenges Challenges exist e.g. for data management. Although remote monitoring results in lesser in-person evaluations, receiving facilities have to handle a significant volume of remotely acquired data. However, appropriate programming and a degree of inbuilt processing resulted in a low event notification rate with Home Monitoring, and when sent, alerts carried high predictive value for actionability [22,46,47]. The ability to process several parameters and notify deviation in a pre-specified combination improves the specificity of alerts e.g. for lead fracture or oxytocin antagonist failure detection [40,48]. Transferring this computing responsibility from implanted unit (necessarily limited) to an external service center is an important advantage of wirelessly transmitted data with high frequency and may enable some detection algorithms [49]. Concerns exist about liability posed and data overload, and above all cost. Liability concerns center around alerts received but not acted on, although remote monitoring is not an emergency system. However, the author is unaware of any legal challenges occurring in over a decade of use of automatic remote monitoring. The counterargument is that, since remote monitoring outperforms traditional methods, future questions may be directed to why the security of comprehensive coverage was not chosen. The cost of the implantable technology cannot be ignored. Costs to manufacturer result from embedded transmission system, the transceiver, warranties and running costs of cellular transmissions. Enabled devices command premium rates, beyond already formidable levels, for self paying patients.
    Summary Results from large randomized prospective trials of all types of CIEDs from different manufacturers, and conducted in different countries, consistently indicate superior performance to conventional care for achieving the current follow-up goals of patient retention and early problem discovery, improving patient safety and convenience, yet promoting clinic efficiencies. The call from professional organizations for development of intensive and comprehensive monitoring of implantable devices, to better manage CIEDS, has been well met by modern remote monitoring technologies [29,30]. However, their capabilities extend beyond this and may enable clinical interventional strategies aiming to influence disease progression (e.g. heart failure) which demand frequent data collection with early notification of parameter deviations [40]. This intent has been thwarted previously when using systems relying on patient participation, which wanes rapidly over prolonged time periods [38], but this problem is avoided by automatic remote monitoring. Thus, a retrospective analysis of almost 70,000 subjects from the ALTITUDE Safety Study database suggested that patients assigned to remote management had improved survival [45] i.e. use of this technology has a direct and positive effect on patient outcomes.