Ošmera O, Bulava A
Kardiologicke oddeleni Nemocnice Ceske Budejovice.
Vnitr Lek. 2013 Apr;59(4):269-76.
An increasing number of patients with implantable devices in cardiology raises the need for better and more efficient outpatient followup. Telemonitoring (remote monitoring) can be widely used as an important part of care for the patient and the device itself due to the technological progress in communication and transmission systems and implantable devices themselves.
To evaluate the benefits of continuous remote monitoring system using Home Monitoring (HM)TM (BIOTRONIK) compared with standard outpatient controls.
198 patients (67 ± 12 years, 80.8 % men) who have been implanted a single chamber or dual- chamber implantable cardioverter defibrillator (ICD) (163/ 35) in 2008- 2009 in the primary or secondary prevention (75/ 123) of sudden cardiac death were followed prospectively. Planned and emergency visits, hospitalization for events related to ICD, delivered shock therapies and their adequacy were evaluated in a group of patients followed in a standard way of outpatient visits (HM- ) and a group telemonitored by HM system (HM+).
A significant reduction was achieved in the number of planned (48 %) and total controls (45 %) during a three years follow up. There was a comparable number of patients who experienced one or more shock therapy (only with a trend to a lower number of patients who obtained a shock in HM+ group, p = 0.25), and there was equivalent mortality of both groups and the number of patients hospitalized in relation to ICD. However there was a success in significant reduction in the number and proportion of inadequate shocks delivered in HM+ patient group by 80 % in ambulatory follow up and by 90 % including multiple shocks, which required a hospitalization.
The HM system demonstrates an effective and safe way of ICD patients followup which helps to reduce the number of outpatient visits and inadequate shock therapies in longterm monitoring.
心脏病学领域中植入式设备的患者数量不断增加，这就需要更好、更高效的门诊随访。由于通信和传输系统以及植入式设备本身的技术进步，远程监测（远程监控）作为患者护理和设备本身护理的重要组成部分可被广泛应用。
评估使用家庭监测（HM）TM（百多力公司）的连续远程监测系统与标准门诊对照相比的益处。
前瞻性随访了198例患者（年龄67±12岁，男性占80.8%），这些患者在2008 - 2009年期间植入了单腔或双腔植入式心脏复律除颤器（ICD）（163/35），用于心脏性猝死的一级或二级预防（75/123）。对一组采用标准门诊随访方式的患者（HM -）和一组通过HM系统进行远程监测的患者（HM +），评估了计划内和急诊就诊情况、因与ICD相关事件的住院情况、电击治疗的实施及其适当性。
在三年随访期间，计划内检查次数（减少48%）和总检查次数（减少45%）均显著降低。经历一次或多次电击治疗的患者数量相当（仅HM +组接受电击的患者数量有减少趋势，p = 0.25），两组的死亡率以及因ICD住院的患者数量相当。然而，HM +患者组在门诊随访中不适当电击的数量和比例显著降低了80%，包括需要住院治疗的多次电击情况，降低了90%。
HM系统展示了一种有效且安全的ICD患者随访方式，有助于在长期监测中减少门诊就诊次数和不适当的电击治疗。
