Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, Ohio, USA.
Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, Ohio, USA.
JACC Clin Electrophysiol. 2021 Jun;7(6):745-754. doi: 10.1016/j.jacep.2020.10.014. Epub 2021 Jan 27.
This study reports resource use and economic implications of rhythm monitoring with subcutaneous cardiac rhythm monitors (SCRMs).
SCRMs generate a substantial amount of data that requires timely adjudication for appropriate clinical care. Resource use for SCRM monitoring is not known.
The study included consecutive transmissions during 4 weeks from 1,811 SCRMs. Resource use was quantified by assessment of time commitment of device clinic personnel and electrophysiologists for data adjudication. Incidence and characteristics of false positive (FP) episodes were assessed. Impact of custom programming for arrhythmia detection on incidence of FP episodes and resource use was analyzed.
A total of 1,457 transmissions (alerts = 462; full downloads = 995) were received during study period. Average device clinic personnel time for adjudication of 1 transmission was 15 ± 6 min. This totaled to 364 h spent (2.3 full-time staff) over the 4-week period, which translated into a salary cost of $12,000 U.S. dollars (USD). Average time spent by an electrophysiologist for 1 transmission was 1.5 ± 1 min and totaled to 37 h for 4 weeks, which translated into an estimated cost of $9,600 USD. Of 1,457 total transmissions, 512 (35%) represented multiple transmissions from the same patients, which resulted in no additional reimbursement. Incidence of FP episodes in the entire cohort was 50% and was variable in alert (60%) and full download (49%) (p = 0.04) transmissions. When SCRMs with manufacturer suggested nominal programming and institutional custom programming were compared, there was a reduction in FP episodes (55% vs. 16%; p = 0.01), which translated to a 34% reduction in resource use for data adjudication.
SCRM data adjudication requires significant resources. Custom programming for SCRMs may overcome the data deluge.
本研究报告了使用皮下心律监测器（SCRM）进行心律监测的资源利用情况和经济影响。
SCRM 会产生大量数据，需要及时判断以进行适当的临床护理。目前尚不清楚 SCRM 监测的资源利用情况。
本研究纳入了 1811 个 SCRM 在 4 周内的连续传输数据。通过评估设备诊所人员和电生理学家用于数据判断的时间投入来量化资源使用情况。评估了假阳性（FP）事件的发生率和特征。分析了为心律失常检测进行定制编程对 FP 事件发生率和资源使用的影响。
研究期间共收到 1457 次传输（警报=462 次；全下载=995 次）。平均每个传输的设备诊所人员判决时间为 15±6 分钟。这总共在 4 周内花费了 364 小时（2.3 名全职员工），换算成工资成本为 12000 美元（USD）。平均每个传输电生理学家的时间为 1.5±1 分钟，总共为 4 周 37 小时，换算成估计成本为 9600 美元（USD）。在总共 1457 次传输中，512 次（35%）代表来自同一患者的多次传输，这导致没有额外的报销。整个队列的 FP 事件发生率为 50%，在警报（60%）和全下载（49%）（p=0.04）传输中有所不同。当将具有制造商建议的标称编程和机构定制编程的 SCRM 进行比较时，FP 事件的发生率降低（55%比 16%；p=0.01），这意味着数据判断的资源使用减少了 34%。
SCRM 数据判断需要大量资源。SCRM 的定制编程可能会克服数据泛滥。
