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Devicebasiertes Telemonitoring

Aktuelle Studienlage

Device-based remote monitoring

Current evidence

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Zusammenfassung

Devicebasierte telemedizinische Behandlungsmöglichkeiten halten weiter Einzug in die Kardiologie. Sie betreffen die frühzeitige Erkennung von Arrhythmien, die Kontrolle der Devicefunktion oder auch die Steuerung und Optimierung der Herzinsuffizienztherapie. Die besten Daten existieren aktuell für die telemedizinisch unterstützte technische Devicenachsorge. In verschiedenen Studien konnte die Belastung des Gesundheitssystems in Form von ambulanten Kontrollen oder stationären Aufenthalten und die Zeit vom Auftreten der Fehlfunktion bis zur Erkennung durch den betreuenden Arzt signifikant reduziert werden. Auch die Rate an inadäquaten ICD-Therapien (ICD: implantierbarer Kardioverter-Defibrillator) kann durch den Einsatz der Telemedizin reduziert werden. Anhand von retrospektiven Daten und Metaanalysen ist die telemedizinische Nachsorge von Patienten auch mit einer reduzierten Mortalität assoziiert. Die devicebasierte Detektion von Vorhofflimmern und atrialen Hochfrequenzepisoden ist technisch möglich. Die Relevanz dieser Technologien und die daraus folgenden medizinischen Interventionen werden aktuell in randomisierten Studien untersucht. In der telemedizinisch gestützten Therapie der Herzinsuffizienz verbesserten Interventionen auf Basis von Surrogatparametern das Outcome nicht relevant, allerdings konnte die Therapiesteuerung basierend auf der Messung des pulmonalarteriellen Drucks Morbidität und Mortalität signifikant senken. Diese Übersichtsarbeit bietet eine Zusammenfassung der aktuellen Datenlage zur devicebasierten telemedizinisch gestützten Nachsorge und Therapie.

Abstract

Telemedicine is increasingly used in clinical cardiology. It offers early detection of arrhythmias, technical device follow-up and support of heart failure management. Regarding technical device follow-up, remote monitoring significantly reduces usage of the health care system. Furthermore, remote monitoring is associated with a significantly reduced time from device malfunction to physician’s perception of the event. Using remote monitoring, inappropriate ICD (implantable cardioverter defibrillator) shocks can be significantly reduced compared to routine in-office follow-up. In retrospective studies and meta-analyses a prognostic benefit with respect to mortality has been shown. Device-based detection of atrial fibrillation and atrial high rate episodes is feasible. However, clinical relevance is currently studied in prospective randomized clinical trials. Heart failure management based on surrogate parameters has not been shown to significantly improve outcome. However, therapeutic management based on pulmonary artery pressure has been shown to significantly reduce morbidity and mortality. This review offers a comprehensive overview on the role of remote monitoring in heart failure management, technical device follow-up and detection of atrial fibrillation and atrial high rate episodes.

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Authors and Affiliations

  1. Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    David Duncker, Roman Michalski,  Johanna Müller-Leisse, Christos Zormpas,  Thorben König &  Christian Veltmann

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  1. David Duncker
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Correspondence to Christian Veltmann.

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Interessenkonflikt

D. Duncker: Vortragshonorare, Reiseunterstützung, Fellowship von Biotronik, Boston Scientific, Medtronic, Sorin/LivaNova, St. Jude Medical/Abbott, Zoll. R. Michalski: Fellowship St. Jude Medical. T. König: Vortragshonorare, Reiseunterstützung, Fellowship von Biotronik, Boston Scientific, Medtronic, Sorin/LivaNova. C. Veltmann: Vortragshonorare, Reiseunterstützung, Beratungstätigkeit von Biotronik, Boston Scientific, Medtronic, St. Jude Medical/Abbott, Zoll. J. Müller-Leisse und C. Zormpas geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Duncker, D., Michalski, R., Müller-Leisse, J. et al. Devicebasiertes Telemonitoring. Herzschr Elektrophys 28, 268–278 (2017). https://doi.org/10.1007/s00399-017-0521-3

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