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Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
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Dr. Lars-Immo Kraemer
For nearly half a decade of cardiac pacing, follow-up has mostly been conducted by regularly timed visits of the patient seeing the physician. With the rapidly evolving complexities of implantable devices as well as communication techniques, new possibilities for remotely monitoring these patients are now technically feasible. Automatic transmission of reports on selected technical and arrhythmic events via GSM net on a daily basis from the implanted device to a central service station are available in some devices today, allowing the physician to access these data on a password-protected web page.
According to Dr. A. Lazarus (FR), the advantages for the patient are early detection of adverse events with the possibility of nearly immediate therapeutic interventions, e.g. at new onset of atrial fibrillation, increasing frequency of ventricular arrhythmias or deterioration of heart failure, as well as reduced expenditures for personal visits. Although home-based follow-up promises to reduce costs for the health care system (e.g. patient transportation) in the long run, its cost-effectiveness is still unproven in randomized trials, as Dr. Giovanni Boriani (IT) pointed out. For the follow-up centre, remote monitoring may reduce the time spent on individual patients, thus permitting them to follow-up more patients in the future. However, as long as the reimbursement of remotely handled reports without personally seeing the patient is not satisfactorily established in most countries, physicians may be reluctant to adopt the new technology, as Dr. Hein Heidbuchel (BE) pointed out.
Remote monitoring of implanted devices will substantially change follow-up of these patients in the future, making it possible to better treat more patients in a shorter time. Issues still to be settled are the cost-effectiveness of this technology as well as reimbursement modalities.
Home-monitoring of devices and implantable cardioverter-defibrillators - how useful is it? Clinical Seminar
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