By Thomas Vogtmann
Thomas Vogtmann reviews expert consensus and guidelines on the adoption of remote monitoring, and discusses how clinical practice might change for the better as a result of its increased usage. He gave this talk at the XV International Symposium on Progress in Clinical Pacing in Rome, Italy
As the number of patients with cardiovascular implantable electronic devices increases rapidly, a clear need has arisen for new technologies that ease patient management and reduce workload and costs. Remote monitoring provides a worthwhile solution to these issues, and the medical technology community has taken note, with four different remote monitoring systems now on the market. Today, they are available in all developed countries on all five continents with rapidly increasing usage.
Indeed, there has been a worldwide proliferation of remote monitoring in a relatively short period of time. A 2010 survey by the European Heart Rhythm Association (EHRA) indicates that by 2015, 57% of centres plan to use remote monitoring in most or all pacemaker patients and 86% of centres plan to use it in most or all ICD patients (Halimi for EHRA, Europace 2010; 12: 1778-80).
Everyone can agree on one thing: remote monitoring is an important and safe tool in reducing in-office follow-ups. The TRUST trial (Varma et al, Circulation 2010, 122, 325–332 and Varma et al, Circ Arrhythm Electrophysiol 2010, 3:428–436) has also proven this for ICDs, and COMPAS (Mabo P et al, Eur Heart J 2012, 33 (9): 1105-1111) for pacemakers. By 2008, the Heart Rhythm Society (HRS) and EHRA had already acknowledged that remote monitoring has the potential to provide timelier information on cardiovascular implantable electronic devices and early detection of relevant technical and clinical events, as studies have clearly demonstrated.
Several new studies added evidence to the time efficiency of Home Monitoring. The MoniC (Model project monitor center) study was recently published on EP Europace (Vogtmann T et al, EP Europace 2012, 15: 219-226). MoniC evaluated the efficiency gains in clinics using Biotronik Home Monitoring and showed that this system is reliable, beneficial and efficient.
Basic screening and communication of relevant arrhythmic and technical events required a total of 1.1 minutes of a physician’s time and 30 minutes of a trained nurse’s time each day per 100 patients monitored by the centre. A study by Ricci et al (Europace 2008; 10: 164-170) also backs-up these findings. Showing that screening and evaluation of Home Monitoring data required 12 minutes of a trained nurse’s time each day per 100 patients and two minutes of a physician’s time.
In spite of the proven clinical benefits of remote monitoring, however, as well as its reduction of costs, many countries have not yet solved the problem of reimbursement, even though remote monitoring has already been acknowledged in their guidelines the most important step for the further adoption of the technology. In 2012 the Netherlands Society of Cardiology made a significant step by releasing its own specific set of guidelines for remote monitoring. These guidelines include issues of programming and address the open questions regarding reimbursement, demanding cost-effectiveness studies (de Cock for Netherlands Society of Cardiology, Neth Heart J 2012; 20: 53-65).
In this new era of cardiovascular implantable electronic devices patient management, the course is set to provide patients with highly reliable and convenient follow-up options while reducing clinical workload and costs to service providers. Next, a strengthened set of clinical guidelines and wider recognition by the local reimbursement systems are needed, bringing the benefits of remote monitoring to a growing number of patients.
Thomas Vogtmann is a cardiologist and electrophysiologist at the Kardiologische Gemeinschaftspraxis Potsdam, Germany, and is a principal investigator of the MoniC study