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[有源植入式心脏电子设备:2017年门诊医疗中能实现什么?]

[Active cardiac implantable electronic devices: What is possible in ambulatory health care in 2017?].

作者信息

Rybak Karin

机构信息

Praxis für Kardiologie und Angiologie, Telemedizinisches Zentrum Dessau, Kochstedter Kreisstraße 11, 06847, Dessau-Roßlau, Deutschland.

出版信息

Herzschrittmacherther Elektrophysiol. 2017 Sep;28(3):279-286. doi: 10.1007/s00399-017-0524-0. Epub 2017 Aug 22.

Abstract

Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. In combination with pacemakers, defibrillators and systems for cardiac resynchronization it is a safe and efficient method for routine technical aftercare of the devices as well as for monitoring heart failure and arrhythmias. Using TM has the potential to optimize patient care with regard to economic, clinical and safety aspects. Despite the good availability of existing data and clear recommendations of the responsible scientific societies, it is often seen as an isolated solution which is not fully integrated into standard care, although it has its own EBM number for implantable cardioverter-defibrillators and cardiac resynchronization therapy systems. The reasons are not only the unsatisfactory reimbursement of costs, different IT structures and the borders between clinics and medical practices, but also acceptance problems of physicians and legal aspects. The compensation of cardiac pacemakers and 'event recorders' is unsolved. TM provides the prospect for optimal and cross-sectoral patient care. Furthermore it has the potential to become the standard method for the care for patients with a CIED.

摘要

几乎所有近期投放市场的心脏植入式电子设备(CIED)都具备远程监测(TM)功能。与起搏器、除颤器及心脏再同步治疗系统相结合,TM对于这些设备的常规技术随访以及监测心力衰竭和心律失常而言,是一种安全且高效的方法。从经济、临床和安全方面来看,使用TM有潜力优化患者护理。尽管现有数据易于获取且相关科学协会也给出了明确建议,但TM常被视为一种孤立的解决方案,未完全融入标准护理中,尽管其针对植入式心律转复除颤器和心脏再同步治疗系统有自己的循证医学编号。原因不仅在于成本报销不尽人意、信息技术结构各异以及诊所与医疗实践之间的界限,还包括医生的接受问题和法律方面。心脏起搏器和“事件记录器”的补偿问题尚未解决。TM为实现最佳的跨部门患者护理提供了前景。此外,它有潜力成为CIED患者护理的标准方法。

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