Cardiology Department, University Hospital of Rome, Tor Vergata, Viale Oxford 81, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2013 Feb;14(2):114-9. doi: 10.2459/JCM.0b013e328354e3e1.
The efficacy and accuracy, as well as patients' satisfaction, of device remote monitoring are well demonstrated. However, the workload of remote monitoring management has not been estimated and reimbursement schemes are currently unavailable in most European countries. This study evaluates the workload associated with remote monitoring systems.
A total of 154 consecutive implantable cardioverter defibrillator patients (age 66±12 years; 86.5% men) with a remote monitoring system were enrolled. Data on the clinician's workload required for the management of the patients were analyzed.
A total of 1744 transmissions were received during a mean follow-up of 15.3±12.4 months. Median number of transmissions per patient was 11.3. There were 993 event-free transmissions, whereas 638 transmissions regarded one or more events (113 missed transmissions, 141 atrial events, 132 ventricular episodes, 299 heart failure-related transmissions, 14 transmissions regarding lead malfunction and 164 transmissions related to other events). In 402 cases telephonic contact was necessary, whereas in 68 cases an in-clinic visit was necessary and in 23 of them an in-clinic visit was prompted by the manufacturer due to technical issues of the transmitter. During follow-up, 316 work hours were required to manage the enrolled patients. Each month, a total of 14.9 h were spent on the remote monitoring of 154 patients (9.7 h for 100 patients monthly) with approximately 1.1±0.15 h per year for each patient.
The clinician's work burden is high in patients with remote monitoring. In order to expand remote monitoring in all patients, reimbursement policies should be considered.
设备远程监测的疗效和准确性以及患者满意度已得到充分证明。然而，远程监测管理的工作量尚未得到评估，并且在大多数欧洲国家目前都没有报销计划。本研究评估了与远程监测系统相关的工作量。
共纳入 154 例连续植入式心脏复律除颤器患者（年龄 66±12 岁；86.5%为男性），这些患者均配备了远程监测系统。分析了管理这些患者所需的临床医生工作量的数据。
在平均 15.3±12.4 个月的随访期间共接收了 1744 次传输。每位患者的中位数传输次数为 11.3 次。其中 993 次为无事件传输，而 638 次与一个或多个事件有关（113 次漏传，141 次心房事件，132 次心室发作，299 次心力衰竭相关传输，14 次与导联故障有关的传输和 164 次与其他事件有关的传输）。在 402 例情况下需要进行电话联系，在 68 例情况下需要进行门诊就诊，在 23 例情况下由于发射器的技术问题需要制造商进行门诊就诊。在随访期间，管理纳入的患者共需要 316 个工作小时。每个月，总共需要 14.9 小时来监测 154 名患者的远程监测（每月 100 名患者需要 9.7 小时），每位患者每年大约需要 1.1±0.15 小时。
远程监测患者的临床医生工作负担很重。为了将远程监测扩展到所有患者，应考虑报销政策。
