An optimized remote monitoring model for ICD recipients reduced alerts requiring cardiologist review from 33% to 18% (P<0.001) and decreased mean alert management time from 4 min 31 s to 2 min 10 s.
Observational (n=562)
Does an optimized remote monitoring organization model using decisional trees improve resource utilization and management time in ICD recipients?
An optimized remote monitoring workflow using decisional trees significantly reduces healthcare resource consumption and time burden without increasing hospitalizations or visits.
Absolute Event Rate: 18% vs 33%
p-value: p=<0.001
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are a standard means of sudden cardiac death prevention. Compared with ambulatory visits, remote monitoring (RM) of ICD recipients has improved the quality of health care and spared its resources. Few studies have addressed the organization of RM. We optimized and validated our institutional model of RM organization for ICD recipients. METHODS AND RESULTS: This observational study of 562 ICD recipients compared 2 RM periods consisting of iterative, qualitative, and quantitative (1) device diagnostic evaluations by nurses and cardiologists; and (2) selected decisional trees. The main study end points were the professional interventions prompted by, and times allocated to, RM alerts. During the first period, 1134 alerts occurred in 427 patients (286 patient-year), of which 376 (33%) were submitted to cardiologists' reviews, compared with, 1522 alerts in 562 patients (458 patient-year), of which 273 (18%) were submitted to cardiologists' reviews during the second period (P<0.001). An intervention was prompted by 73 of 376 (19.4%) alerts in the first versus 77 of 273 (28.2%) in the second period (P=0.009). The mean time to manage an alert was 4 minutes 31 s in the first versus 2 minutes 10 s in the second period (P<0.001). The annual numbers of alert-related hospitalizations were 10.8 versus 8.1 per 100-patient-year (P=0.230), and annual numbers of alert-related visits were 9.8 and 6.1 per 100-patient-year (P=0.081), respectively. CONCLUSIONS: An optimized RM organization based on automated alerts and decisional trees enabled a focus on clinically relevant events and a decrease in the consumption of resources without compromising the quality of ICD recipients' care.
Guédon-Moreau et al. (Wed,) conducted a observational in Implantable cardioverter-defibrillator (ICD) recipients (n=562). Optimized remote monitoring organization (second period) vs. Standard remote monitoring organization (first period) was evaluated on Proportion of remote monitoring alerts submitted to cardiologists' reviews (p=<0.001). An optimized remote monitoring model for ICD recipients reduced alerts requiring cardiologist review from 33% to 18% (P<0.001) and decreased mean alert management time from 4 min 31 s to 2 min 10 s.
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