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Recommendations on the utilization of telemedicine in cardiology

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Summary

The enormous progress made in recent years in the field of information and communication technology and also in sensor and computer technology has affected numerous fields of medicine and is capable of inducing even radical changes in diagnostic and therapeutic processes. This is particularly true for cardiology, where, for example, telemetric monitoring of cardiac and circulatory functions has been in use for many years. Nevertheless, broad application of newer telemedical processes has not yet been achieved to the extent one would expect from the encouraging results of numerous clinical studies in this field and the state of the art of the underlying technology. In the present paper, the Working Group on Rhythmology of the Austrian Cardiological Society aims to provoke a critical discussion of the digital change in cardiology and to make recommendations for the implementation of those telemedical processes that have been shown to exert positive effects on a wide variety of medical and economic parameters. The greatest benefit of telecardiological applications is certainly to be found in the long-term care of patients with chronic cardiovascular diseases. Accordingly, follow-up care of patients with cardiological rhythm implants, management of chronic heart failure and secondary prevention following an acute cardiac event during rehabilitation are currently the most important fields of application. Telemedicine is intended to enable high-quality and cost-efficient care for an increasing number of patients, whose care poses one of the greatest challenges to our healthcare system. Not least of all, telemedicine should make a decisive contribution to improving the quality of life of this segment of the population by favorably influencing mortality, morbidity and hospitalization as well as the patient’s contribution to treatment.

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Abbreviations

AAI:

Single chamber atrial pacing

AAIR:

Single chamber atrial rate response pacing

ACS:

Acute coronary syndrome

AF:

Atrial fibrillation

AHA:

American Heart Association

AHRE:

Atrial high-rate episode

AI:

Artificial intelligence

ATP:

Antitachycardia pacing

CDA:

Clinical document architecture

CHD:

Coronary heart disease

CIED:

Cardiac implantable electronic device

CR:

Cardiac rehabilitation

CRT:

Cardiac resynchronization therapy

CRT‑P:

Cardiac resynchronization therapy-pacing only

CRT‑D:

Cardiac resynchronization therapy with defibrillator/cardioverter back-up

CTR:

Cardiac telerehabilitation

DDD:

Dual chamber sequential pacing

DDDR:

Dual chamber sequential rate response pacing

DGK:

German Society for Cardiology

DMP:

Disease management program

ELGA:

“Elektronische Gesundheitsakte” (Electronic health records)

ERAP:

Expanded rehabilitation/aftercare program

ERI:

Elective replacement indicator

ESC:

European Society of Cardiology

HFA:

Heart Failure Association of the ESC

HL7:

Health Level Seven International

HRS:

Heart Rhythm Society

ICD:

Implantable defibrillator cardioverter

ICT:

Information and communication technology

IEGM:

Intracardiac electrogram

ILR:

Implantable loop recorder

IT:

Information technology

NYHA:

New York Heart Association

ÖKG:

Austrian Cardiological Society

PDA:

Personal digital assistant

PM:

Pacemaker

R:

Rehabilitation

RI:

Remote interrogation

RM:

Remote monitoring

RRT:

Recommended replacement time

S‑ICD:

Subcutaneous implantable defibrillator cardioverter

TM:

Telemedicine

TMC:

Telemedical center

TR:

Telerehabilitation

VC:

Videoconferencing

VVI:

Single chamber ventricular pacing

VVIR:

Single chamber ventricular rate response pacing

WHO:

World Health Organization

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Authors and Affiliations

  1. Hauptstelle-Abt. Forschung, Innovation, Leistungsentwicklung, Pensionsversicherungsanstalt, Friedrich Hillegeist-Straße 1, 1021, Vienna, Austria

    Michael Gruska

  2. Institut für Ethik und Recht in der Medizin, Universität Wien, Spitalgasse 2–4, Hof 2.8, 1090, Vienna, Austria

    Gerhard Aigner

  3. SKA-Rehabilitationszentrum Großgmain, Salzburger Straße 520, 5084, Großgmain, Austria

    Johann Altenberger

  4. 2. Med. Abteilung, Hanusch Krankenhaus, Heinrich-Collin-Straße 30, 1140, Vienna, Austria

    Dagmar Burkart-Küttner

  5. 2. Interne Abteilung, Landesklinikum Wr. Neustadt, Corvinusring 3–5, 2700, Wiener Neustadt, Austria

    Lukas Fiedler & Alexander Teubl

  6. Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Marianne Gwechenberger & Christoph Schukro

  7. Klinische Abteilung für Kardiologie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    Peter Lercher & Daniel Scherr

  8. 2. Interne Abteilung, Ordensklinikum Linz, Krankenhaus der Elisabethinen, Fadingerstraße 1, 4020, Linz, Austria

    Martin Martinek

  9. 3. Medizinische Abteilung, Wilheminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria

    Michael Nürnberg

  10. Universitätsklinik für Innere Medizin III, Medizinische Universität Innsbruck, Anichstraße, 6020, Innsbruck, Austria

    Gerhard Pölzl & Markus Stühlinger

  11. Privatkrankenanstalt Rudolfinerhaus, Billrothstraße 78, 1190, Vienna, Austria

    Gerold Porenta

  12. Medical Engineering & eHealth, FH Technikum Wien, Höchstädtplatz 6, 1200, Vienna, Austria

    Stefan Sauermann

  13. Klinik für Kardiologie und internistische Intensivmedizin, Med Campus III, Kepler Universitätsklinikum, Krankenhausstraße 9, 4021, Linz/Donau, Austria

    Clemens Steinwender

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  1. Michael Gruska
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  2. Gerhard Aigner
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  15. Clemens Steinwender
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  17. Alexander Teubl
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Working Group Rhythmology of the Austrian Cardiological Society

Corresponding author

Correspondence to Michael Gruska.

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Conflict of interest

M. Gruska has received research grants and/or honoraria from the following companies: Biotronik. L. Fiedler has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Boston Scientific. M. Gwechenberger has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Boston Scientific, Medtronic. P. Lercher has received research grants and/or honoraria from the following companies: Biotronik, Medtronic. M. Martinek has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Boston Scientific, Medtronic. M. Nürnberg has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Boston Scientific, Medtronic. C. Schukro has received research grants and/or honoraria from the following companies: Biotronik, Boston Scientific, Medtronic. D. Scherr has received research grants and/or honoraria from the following companies: Biotronik, Medtronic, Zoll. C. Steinwender has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Boston Scientific, Medtronic. M. Stühlinger has received research grants and/or honoraria from the following companies: Biotronik, Medtronic. A. Teubl has received research grants and/or honoraria from the following companies: Abbott, Biotronik, Microport. G. Aigner, J. Altenberger, D. Burkart-Küttner, G. Pölzl, G. Porenta and S. Sauermann declare that they have no competing interests.

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The present recommendations were approved by the Austrian Cardiological Society in a resolution adopted by the Board of Directors on 2 March 2020.

All authors contributed equally to this position paper on behalf of the Working Group Rhythmology of the Austrian Cardiological Society.

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Gruska, M., Aigner, G., Altenberger, J. et al. Recommendations on the utilization of telemedicine in cardiology. Wien Klin Wochenschr 132, 782–800 (2020). https://doi.org/10.1007/s00508-020-01762-2

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