Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands

Netherlands Heart Journal, Feb 2012

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession.

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Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands

C. C. de Cock 0 1 3 4 5 6 7 8 9 J. Elders 0 1 3 4 5 6 7 8 9 N. M. van Hemel 0 1 3 4 5 6 7 8 9 K. van den Broek 0 1 3 4 5 6 7 8 9 L. van Erven 0 1 3 4 5 6 7 8 9 B. de Mol 0 1 3 4 5 6 7 8 9 J. Talmon 0 1 3 4 5 6 7 8 9 D. A. M. J. Theuns 0 1 3 4 5 6 7 8 9 W. de Voogt 0 1 3 4 5 6 7 8 9 0 N. M. van Hemel Heart Lung Center, Utrecht University , P.O. Box 80125, Utrecht, the Netherlands 1 J. Elders Department of Cardiology, Canisius Wilhelmina Hospital , Weg door Jonkerbos 100, 6500 GS Nijmegen, the Netherlands 2 ) Department of Cardiology, VU University Medical Center , Boelelaan 1117, 1081 HV Amsterdam, the Netherlands 3 W. de Voogt Department of Cardiology, Sint Lucas Andreas Hospital , Tooropsstraat 164, 1961 AE Amsterdam, the Netherlands 4 D. A. M. J. Theuns Department of Electrophysiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands 5 J. Talmon Department of Medical Informatics, Maastricht University , P.O. Box 616, 6200 MD Maastricht, the Netherlands 6 B. de Mol Department of Cardio-thoracic Surgery, Academic Medical Center , Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands 7 L. van Erven Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands 8 K. van den Broek Department of Medical Psychology, Tilburg University , Warandelaan 2, 5037 AB Tilburg, the Netherlands 9 Organisational and writing committee: CC de Cock, MD PhD, Department of Cardiology , VUmc, Amsterdam ; J Elders, RN MA, Department of Cardiology, Canisius Wilhelmina Hospital , Nijmegen ; NM van Hemel, MD PhD, Prof Em, Utrecht University Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patienttriggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession. - Abbreviations AF Atrial fibrillation CIED Cardiovascular implantable electronic device CRT Cardiac resynchronization therapy DDDR Mode of atrial-ventricular cardiac pacing DICOM Digital imaging and communications in medicine EPR Electronic patient record EHR Electronic health record ERI Elective replacement indicator GPRS General packet radio service GSM Global system for mobile communications GUI Graphical user interface HL7 Health level seven, international healthcare standard https Secure internet connection ICD Implantable cardioverter defibrillator IDCO Implantable devicecardiacobservation IHE Integrating the healthcare enterprise NEN Nederlands normalisatie-instituut NTA Nederlandse Technische Afspraak PM Pacemaker SMS Short message service VVIR Mode of ventricular cardiac pacing VT Ventricular tachycardia Chapter 1: introduction Cardiovascular implantable electronic devices (CIED) are categorised as implantable pacemakers (PM), implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy devices with or without a cardiac defibrillator and cardiac arrhythmia monitor devices. After CIED implantation regular technical checks of the CIEDS are mandatory to examine the performance, safety and remaining longevity of the implanted device. In addition, an in-hospital examination of the device recipient (device patient) is sometimes needed to evaluate his/her physical and mental condition and if required, to adjust the function of the CIED to the changing needs of the device recipient. Guidelines recommend the frequency and intensity of these medical and technical follow-up visits. [1, 2] Recently remote CIED interrogation from a patients (...truncated)


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C. C. de Cock, J. Elders, N. M. van Hemel, K. van den Broek, L. van Erven, B. de Mol, J. Talmon, D. A. M. J. Theuns, W. de Voogt. Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands, Netherlands Heart Journal, 2012, pp. 53-65, Volume 20, Issue 2, DOI: 10.1007/s12471-011-0239-5