Key result
A dedicated organizational model for remote monitoring was established in 86% of centers, typically involving two physicians and one nurse, and primarily offered to ICD and CRT patients.
Cross-Sectional (n=49)
Yes
Remote monitoring services for CIEDs in Italy are predominantly nurse-led with physician support, primarily targeting ICD and CRT patients, with high responsiveness to technical and arrhythmia alerts but less use of heart failure indices.
Supports nurse-led RM models with physician oversight for ICD/CRT patients; leaves open effects on HF indices use and clinical outcomes.
BACKGROUND: This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. METHODS: A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. RESULTS: A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out-of-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. CONCLUSIONS: This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.
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Zanotto et al. (2018) conducted a cross-sectional in Cardiac implantable electronic devices (CIEDs) remote monitoring (n=49). Remote monitoring organizational models was evaluated on Organizational workflow and reactions to alerts in remote monitoring service. A dedicated organizational model for remote monitoring was established in 86% of centers, typically involving two physicians and one nurse, and primarily offered to ICD and CRT patients.