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Remote monitoring of implantable cardioverter-defibrillators

Problems and implications using a telemonitoring system

Fernüberwachung implantierbarer Cardioverter-Defibrillatoren

Probleme und Erfahrungen mit einem telemedizinischen Nachsorgesystem

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Abstract

The rising number of implantable devices has led to an increase in device-related workload, e.g., regular interrogation follow-up visits. Telemonitoring systems for implantable cardioverter-defibrillators (ICDs) seem to be a promising tool for reducing workload and costs, and they have the potential of optimizing patient care. However, issues such as practical functionality of ICD telemonitoring in daily routine may affect its broad implementation. The objective of this study was to evaluate potential problems during the implementation of a telemonitoring system, Medtronic CareLink™ (CL™) with respect to the installation and data transmission process. A total of 159 patients with ICDs who were equipped with the CL™ system were evaluated and followed up for 16 months regarding the success rate of the first data transmission via the telemonitoring system. In this cohort, a high rate of nontransmission of 23.9 % was observed after the 16-month follow-up. A detailed interview of these patients (no transmission) revealed that the main reasons for failed transmissions were due to the patients’ loss of interest in the concept (approximately 50 %) as well as technical problems (approximately 25 %) with setting up the system. These results indicate that telemonitoring systems bear potential problems and that the evaluation of patient motivation and technical support options seems to play an important role in establishing the functionality of these systems.

Zusammenfassung

Die steigende Zahl kardialer implantierbarer Systeme führt zu einem Anstieg der gerätebedingten Arbeitsbelastung, wie z. B. regelmäßige Nachuntersuchungen. Heimnachsorgesysteme für implantierbare Cardioverter-Defibrillatoren (ICD) erscheinen vielversprechend zur Verminderung von Arbeitsbelastung und Kosten und bieten die Aussicht auf eine Optimierung der Patientenversorgung. Jedoch könnten Probleme wie die Praktikabilität im täglichen Gebrauch des ICD-Heimnachsorgesystems deren breite Etablierung beeinflussen. Ziel dieser Arbeit war es, mögliche Probleme bei der Einführung eines ICD-Heimnachsorgesystems, des Medtronic CareLink™ (CL™) Systems, im Hinblick auf seine Praktikabilität für den Patienten im täglichen Gebrauch, v.a. im Hinblick auf den Installationsprozess und erfolgreiche Datenübertragung zu untersuchen. Insgesamt wurden 159 Patienten mit ICD in diese Untersuchung eingeschlossen und für 16 Monate in Bezug auf die Erfolgsrate der ersten Datenübertragung sowie hinsichtlich der Gründe gescheiterter Übertragungen via Heimnachsorgesystem nachverfolgt. Unsere Analyse ergab eine initial (6 Monate nach Studieneinschluss) erfolgreiche Erstübertragung bei 61,6% der Patienten (98/159), nach 16 Monaten zeigte sich eine Übertragungsrate von 76,1% (121/159 Patienten). Bei insgesamt 38 Patienten erfolgte keine erfolgreiche Übertragung (Abb. 2). Als Hauptgrund für fehlenden Übertragungserfolg konnte in der Hälfte dieser Fälle (19/38 Patienten) ein mangelndes Interesse an dem Heimnachsorge-Konzept eruiert werden. Das mangelnde Interesse wurde überwiegend durch eine mentale Überforderung im Umgang mit dem System begründet. 10/38 Patienten (26.3%) gaben technische Probleme mit dem System als Ursache für die nicht erfolgte Erstübertragung an (Abb. 3b). In weiteren Subanalysen konnte zudem eine kurze Anreisedistanz (<43 km) des Patienten zur betreuenden Klinik als signifikanter Prädiktor für einen Übertragungsmisserfolg identifiziert werden (Abb. 4a). Zusammenfassend identifizierte unsere „real-life“ Untersuchung relativ niedrige Übertragungsraten mit einem telemedizinischen ICD-Heimnachsorgesystem. Interessensverlust (aufgrund mentaler Überforderung) sowie technische Probleme scheinen hierbei eine wesentliche kausale Rolle zu spielen. Basierend auf diesen Ergebnissen sollten potentielle Kandidaten für eine ICD-Heimnachsorge daher auch nach der individuellen Motivation ausgewählt bzw. ausführlich über den potentiellen Nutzen eines solchen Systems informiert werden. Zudem sollte eine Unterstützung (technischer Support) für die schnelle Lösung von Problemen gewährleistet sein.

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Acknowledgments

This study contains elements of the doctoral thesis of Johannes Siebermair.

Compliance with ethical guidelines

Conflict of interest. S. Clauss, E. Martens, F. Schuessler, N. Oversohl, N. Haserueck, H.L. Estner, S. Kääb, and R. Wakili state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Medicine I, Hospital of the Ludwig Maximilians University Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany

    J. Siebermair, S. Clauss, E. Martens, F. Schuessler, N. Oversohl, N. Haserueck, H.L. Estner, S. Kääb MD, PhD & R. Wakili

  2. Partner Site Munich Heart Alliance, Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich, Germany

    S. Kääb MD, PhD

Authors
  1. J. Siebermair
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  2. S. Clauss
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  3. E. Martens
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  4. F. Schuessler
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  5. N. Oversohl
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  6. N. Haserueck
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  7. H.L. Estner
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  8. S. Kääb MD, PhD
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  9. R. Wakili
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Corresponding author

Correspondence to S. Kääb MD, PhD.

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Siebermair, J., Clauss, S., Martens, E. et al. Remote monitoring of implantable cardioverter-defibrillators. Herz 40 (Suppl 2), 110–118 (2015). https://doi.org/10.1007/s00059-014-4080-7

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  • DOI: https://doi.org/10.1007/s00059-014-4080-7

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