Vnitr Lek 2013, 59(4):269-276

The benefits of a remote monitoring system in long-term follow up of patients with implantable cardioverter-defibrillators

O. Ošmera^1,*, A. Bulava^1,2

¹ Kardiologické oddělení Nemocnice České Budějovice, a.s., přednosta prim. MUDr. František Toušek, FESC

² Zdravotně sociální fakulta Jihočeské univerzity České Budějovice, děkanka prof. PhDr. Valérie Tóthová, Ph.D.

Introduction:
An increasing number of patients with implantable devices in cardiology raises the need for better and more efficient outpatient follow-up. Telemonitoring (remote monitoring) can be widely used as an important part of care for the patient and the device itself due to the technological progress in communication and transmission systems and implantable devices themselves.

Objectives:
To evaluate the benefits of continuous remote monitoring system using Home Monitoring (HM)^TM (BIOTRONIK) compared with standard outpatient controls.

Patients and methods:
198 patients (67 ± 12 years, 80.8 % men) who have been implanted a single-chamber or dual-chamber implantable cardioverter-defibrillator (ICD) (163/35) in 2008-2009 in the primary or secondary prevention (75/123) of sudden cardiac death were followed prospectively. Planned and emergency visits, hospitalization for events related to ICD, delivered shock therapies and their adequacy were evaluated in a group of patients followed in a standard way of outpatient visits (HM-) and a group telemonitored by HM system (HM+).

Results:
A significant reduction was achieved in the number of planned (48 %) and total controls (45 %) during a three-years follow up. There was a comparable number of patients who experienced one or more shock therapy (only with a trend to a lower number of patients who obtained a shock in HM+ group, p = 0.25), and there was equivalent mortality of both groups and the number of patients hospitalized in relation to ICD. However there was a success in significant reduction in the number and proportion of inadequate shocks delivered in HM+ patient group by 80 % in ambulatory follow up and by 90 % including multiple shocks, which required a hospitalization.

Conclusion:
The HM system demonstrates an effective and safe way of ICD patients follow-up which helps to reduce the number of outpatient visits and inadequate shock therapies in long-term monitoring.

Keywords: remote monitoring; Home Monitoring; implantable cardioverter-defibrillator

Received: December 17, 2012; Accepted: February 19, 2013; Published: April 1, 2013  Show citation