心脏植入式电子设备患者的远程监测：一项东南亚单中心试点研究。
Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study.
作者信息
Lim Paul Chun Yih, Lee Audry Shan Yin, Chua Kelvin Chi Ming, Lim Eric Tien Siang, Chong Daniel Thuan Tee, Tan Boon Yew, Ho Kah Leng, Teo Wee Siong, Ching Chi Keong
机构信息
Department of Cardiology, National Heart Centre Singapore, Singapore.
出版信息
Singapore Med J. 2016 Jul;57(7):372-7. doi: 10.11622/smedj.2016120.
INTRODUCTION
Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.
METHODS
Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.
RESULTS
A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.
CONCLUSION
Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.
引言
心脏植入式电子设备（CIED）的远程监测已被证明可提高患者安全性并减少门诊就诊次数。我们报告了我们通过美敦力CareLink（®）网络进行远程监测的经验。
方法
除了常规门诊检查外，对患者进行为期六个月的随访，每月定期进行远程监测传输。通过记录传输的依从性、需要干预的设备警报数量以及从传输到审查的时间来评估远程监测的效果。发放问卷以评估患者、医生和医学技术人员的体验。
结果
共纳入57例患者；16例（28.1%）植入永久性起搏器，34例（59.6%）植入植入式心律转复除颤器，7例（12.3%）植入心脏再同步治疗除颤器。总体而言，在计划的334次远程传输中，73.7%按时进行，14.5%逾期，11.8%漏传。84.6%的无线传输按时进行，而非无线传输的按时率为53.8%。在所有传输中，4.4%包含需要告知医生的警报，仅1.8%需要干预。98.6%的远程传输在第二个工作日内得到审查。73.2%的患者更喜欢远程监测。医生一致认为，97.1%的时间里远程传输提供的信息与门诊检查相当。77.8%的医学技术人员认为远程监测有助于医院改善患者管理。未报告不良事件。
结论
CIED的远程监测是安全可行的。通过更早地检测心律失常或设备故障，允许更早地进行干预，可能对患者安全有益。特别是无线远程监测，可能会提高对设备监测的依从性。由于可能改善生活质量，患者可能更喜欢远程监测。
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