Dr. Bruce Wilkoff
Angelo Aurrichio from Switzerland and I, Bruce Wilkoff from Cleveland in the United States, had the honour of co-chairing the EHRA and Heart Rhythm Society guidance document for the monitoring of cardiac implantable electronic devices earlier this year, and hosted in this session 4 experts on the implementation of remote monitoring in the European Union.
Carina Blomstrom-Lundqvist from Uppsala, Sweden filled us in on the demographics of device implantation and the huge number of patients who need device monitoring, both in person and remotely. ERHA published the details of the estimated numbers throughout Europe from the existing national registries in a white paper. The challenges are significantly related to limited resources, insufficient data and unclear support from national reimbursement agencies. The EHRA/HRS guidance document was summarized. Luc Jordaens from Rotterdam, Netherlands spoke about whether remote home monitoring is safe and reliable. There is no question that the data provided through remote interrogation is accurate and provides diagnostic information about heart rhythms and system function. However, he pointed out the importance of combining remote interrogation follow-up with in person programming evaluations to make sure that the data, which depends on the quality of the lead function, is dependable. Frieder Braunschweig from Stockholm, Sweden talked to us about the cost and value of remote device follow-up. It was clear that there is data proving the cost-effectiveness of home monitoring when the total financial impact is measured. In particular, transportation costs, physician costs and hospital costs are all improved. However, the most important statement was that this issue is as much about safety as it is about cost-effectiveness. Also, Johannes Holzmeister from Zurich, Switzerland helped us understand many of the barriers that make the implementation of consistent remote device monitoring difficult. These barriers include, standards for data management including having a single system for all device manufacturers, inconsistent reimbursement from country to country, training of hospital and clinic staff with the new follow-up paradigms, education of patients to reassure the patients that the doctor will still see them, start up costs, legal liabilities and issues of data ownership. Lastly there were extensive give and take discussions between the audience, speakers and chairmen pointing out how many more details there are to work out in order to fully implement remote device follow-up.
Remote cardiac implantable electronic device follow-up is an important key to providing excellent device therapy. There is an international guidance document providing initial direction on the rolling out of this care pathway and although there is initial evidence of the cost-effectiveness of this approach, the almost complete lack of reimbursement continues to be the major barrier to its implementation.
Home monitoring for electrical devices
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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