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Aktuelle Kardiologie 2016; 5(02): 101-111
DOI: 10.1055/s-0042-105078
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Telemonitoring in der Devicetherapie: gelebte Wirklichkeit?

Telemonitoring in Device Therapy: a Living Reality?
K. Rybak
Kardiologische Praxis, Telemedizinisches Zentrum Dessau
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Publication History

Publication Date:
21 April 2016 (online)

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Zusammenfassung

Nahezu alle auf dem Markt befindlichen implantierbaren Rhythmusdevices eröffnen heute die Möglichkeit des Telemonitorings. Diese Option bietet die Chance, die Betreuung dieser Patienten sowohl unter ökonomischen als auch unter medizinischen und sicherheitstechnischen Aspekten zu optimieren. Die telemedizinische Überwachung von Patienten mit ICD- oder CRT-System fügt sich sinnvoll in das Konzept eines optimierten Herzinsuffizienzmanagements ein. Kardiologische Fachgesellschaften haben das telemedizinische Devicemonitoring in den aktuellen Guidelines bereits positiv bewertet. Die breite Nutzung dieser Option scheitert trotz ausreichender Datenlage, aktuell vor allem am Fehlen einer adäquaten Vergütung telemedizinischer Verfahren im ambulanten und stationären Bereich. Dem Patienten wird u. U. durch den nicht genutzten Einsatz eines technisch möglichen telemedizinischen Devicemonitorings ein höheres Maß an Sicherheit und die frühzeitige Optimierung therapeutischer Ansätze vorenthalten. Im kürzlich verabschiedeten E-Health-Gesetz ist die Telekardiologie unverständlicherweise nicht vorgesehen. Es bleibt zu hoffen, dass im Rahmen künftiger Gesetzesvorhaben die Einführung dieser modernen Optionen in die Regelversorgung ermöglicht wird.

Abstract

Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. Using TM has the potential to optimize patient care with regard to clinical, safety, and economic aspects. Thus, TM of patients with ICD or CRT devices can reasonably be included in a concept of optimized heart failure management. Meanwhile, a number of guidelines or scientific statements provide evidence-based positive recommendations with respect to the use of TM in CIEDs. Despite this fact, a broader application of TM is hampered primarily due to inadequate reimbursement of the technique, both in an outpatient and in-hospital setting. Thus, a considerable number of patients are currently deprived of the advantages of TM such as higher therapeutic safety and promptness of treatment optimization. In contrast to the federal government policy statement to promote the dissemination of TM, telecardiology has not been included into the recently adopted e-Health Act. It remains to be seen whether a future legal bill will facilitate introduction of this promising therapeutic options into standard medical care.

Schlüsselwörter

Telemedizin - Remote-Monitoring - Remote-Follow-up - Devices - Arrhythmien

Key words

telemedicine - remote monitoring - remote follow up - devices - arrhythmias
 

  • Literatur

  • 1 Markewitz A et al. Jahresbericht des Deutschen Herzschrittmacher-und Defibrillatorregisters 2011–2013. Im Internet: http://www.pacemaker-register.de Stand: 03.02.2016
    PubMedGoogle Scholar
  • 2 Kuck KH, Hindricks G, Padeletti L et al. The EHRA White Book 2015. Im Internet: http://www.escardio.org Stand: 03.02.2016
    PubMedGoogle Scholar
  • 3 Burri H. Remote follow-up and continuous remote monitoring, distinguished. Europace 2013; 15: i14-i16
    CrossrefPubMedGoogle Scholar
  • 4 Sanna T, Diener HC, Passmann RS et al. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF). N Engl J Med 2014; 370: 2478-2486
    CrossrefPubMedGoogle Scholar
  • 5 Ricci RP, Morichelli L, Santini M. Remote control of implanted devices through Home Monitoring technology improves detection and clinical management of atrial fibrillation. Europace 2009; 11: 54-61
    CrossrefPubMedGoogle Scholar
  • 6 Varma N, Epstein AE, Irimpen A et al. Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: The Lumos-T safely reduces routine office device follow-up (TRUST) trial. Circulation 2010; 122: 325-332
    CrossrefPubMedGoogle Scholar
  • 7 Lazarus A. Remote, wireless, ambulatory monitoring of implantable pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy systems: analysis of a worldwide database. Pace 2007; 30: 2-12
    PubMedGoogle Scholar
  • 8 Ricci RP. Disease management: atrial fibrillation and home monitoring. Europace 2013; 15: i35-i39
    CrossrefPubMedGoogle Scholar
  • 9 Varma N. Automatic remote home monitoring of implantable cardioverter defibrillator lead and generator function: a system that tests itself everyday. Europace 2013; 15: i26-i31
    CrossrefPubMedGoogle Scholar
  • 10 Mabo P, Defaye P, Sadoul N et al. Remote follow up of patients implanted with an ICD: The prospective randomized EVATEL study (abstr). Heart Rhythm 2012; 9 (Suppl.) S226-S227
    CrossrefPubMedGoogle Scholar
  • 11 Guédon-Moreau L, Kouakam C, Klug D et al. Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial. J Cardiovasc Electrophysiol 2014; 25: 763-770
    CrossrefPubMedGoogle Scholar
  • 12 Parthiban N, Esterman A, Mahajan R et al. Remote monitoring of implantable cardioverter-defibrillators: a systematic review and metaanalysis of clinical outcomes. J Am Coll Cardiol 2015; 65: 2591-2600
    CrossrefPubMedGoogle Scholar
  • 13 Heidbuchel H, Hindricks G, Broadhurst P et al. EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J 2015; 36: 158-169
    CrossrefPubMedGoogle Scholar
  • 14 Koplan BA, Kaplan AJ, Weiner S et al. Heart failure decompensation and allcause mortality in relation to biventricular pacing in patients with heart failure: is a goal of 100 % biventricular pacing necessary?. J Am Coll Cardiol 2009; 53: 355-360
    CrossrefPubMedGoogle Scholar
  • 15 Sack S, Wende CM, Nägele H et al. Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study. Eur J Heart Fail 2011; 13: 1019-1027
    CrossrefPubMedGoogle Scholar
  • 16 Saxon LA, Hayes DL, Roosevelt Gilliam F et al. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up – the ALTITUDE Survival Study. Circulation 2010; 122: 2359-2367
    CrossrefPubMedGoogle Scholar
  • 17 Hindricks G, Taborsky M, Glikson M et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomized controlled trial. Lancet 2014; 384: 583-590
    CrossrefPubMedGoogle Scholar
  • 18 Brachmann J, Böhm M, Rybak K et al. Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Heart Fail 2011; 13: 796-804
    CrossrefPubMedGoogle Scholar
  • 19 Böhm M, Drexler H †, Oswald H et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J 2016; [Epub ahead of print]
    PubMedGoogle Scholar
  • 20 Heidbuchel H, Lioen P, Foulon S et al. Potential role of remote for scheduled and unscheduled evaluations of patients with an implantable defibrillator. Europace 2008; 10: 351-357
    CrossrefPubMedGoogle Scholar
  • 21 Hernández-Madrid A, Lewalter T, Proclemer A et al. Remote monitoring of cardiac implantable electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace 2014; 16: 129-132
    CrossrefPubMedGoogle Scholar
  • 22 Dubner S, Auricchio A, Steinberg JS et al. ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDS). Europace 2012; 14: 278-293
    CrossrefPubMedGoogle Scholar
  • 23 Brignole M, Auricchio A, Baron-Esquivias G et al. ESC Guidelines on cardiac pacing and resynchronization therapy. Eur Heart J 2013; 34: 2281-2329
    CrossrefPubMedGoogle Scholar
  • 24 Slotwiner D, Varma N, Akar JG et al. HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015; 12: e69-e100
    CrossrefPubMedGoogle Scholar
  • 25 Müller A, Rybak K, Klingenheben K et al. Empfehlungen zum Telemonitoring von Patienten mit implantierten Herzschrittmachern, Defibrillatoren und kardialen Resynchronisationssystemen. Kardiologe 2013; 7: 181-193
    CrossrefPubMedGoogle Scholar
  • 26 Halimi F, Clementy J, Attuel P et al. Optimized post-operative surveillance of permanent pacemakers by home monitoring: the OEDIPE trial. Europace 2008; 10: 1392-1399
    CrossrefPubMedGoogle Scholar
  • 27 Crossley GH, Chen J, Choucair W et al. Clinical benefits of remote versus transtelephonic monitoring of implanted pacemakers. J Am Coll Cardiol 2009; 54: 2012-2019
    CrossrefPubMedGoogle Scholar
  • 28 Crossley GH, Boyle A, Vitense H et al. The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial: the value of wireless remote monitoring with automatic clinical alerts. J Am Coll Cardiol 2011; 57: 1181-1189
    CrossrefPubMedGoogle Scholar
  • 29 Mabo P, Victor F, Bazin P et al. A randomized trial of long-term monitoring of pacemaker recipients (the COMPAS trial). Eur Heart J 2012; 33: 1105-1111
    CrossrefPubMedGoogle Scholar
  • 30 Landolina M, Perego GB, Lunati M et al. Remote monitoring reduces healthcare use and improves qualitiy of care in heart failure patients with implantable defibrillators. The Evolution of Management Strategies of Heart Failure Patients with implantable Defibrillators (EVOLVO) study. Circulation 2012; 125: 2985-2992
    CrossrefPubMedGoogle Scholar
  • 31 Guédon-Moreau L, Lacroix D, Sadoul N et al. A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J 2013; 34: 605-614
    CrossrefPubMedGoogle Scholar
  • 32 Ricci RP, Morichelli L, DʼOnofrio A et al. Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry. Europace 2013; 15: 970-977
    CrossrefPubMedGoogle Scholar
  • 33 Boriani G, Da Costa A, Ricci RP et al. The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res 2013; 15: e167
    CrossrefPubMedGoogle Scholar
  • 34 Ricci RP, Morichelli L, Quarta L et al. Long-term patient acceptance of and satisfaction with implanted device remote monitoring. Europace 2010; 12: 674-679
    CrossrefPubMedGoogle Scholar
  • 35 Raatikainen MJ, Uusimaa P, van Ginneken MM et al. Remote monitoring of implantable cardioverter defibrillator patients: a safe, time-saving and cost-effective means for follow-up. Europace 2008; 10: 1145-1151
    CrossrefPubMedGoogle Scholar
  • 36 Marzegalli M, Lunati M, Landolina M et al. Remote monitoring of CRT-ICD: the multicenter Italian CareLink evaluation—ease of use, acceptance and organizational implications. Pacing Clin Electrophysiol 2008; 31: 1259-1264
    CrossrefPubMedGoogle Scholar
  • 37 Versteeg H, Pedersen S, Mastenbroek H et al. Patient perspective on remote monitoring of cardiovascular implantable electronic devices: rationale and design of the REMOTE-CIED study. Neth Heart J 2014; 22: 423-428
    CrossrefPubMedGoogle Scholar
  • 38 Hindricks G, Elsner C, Piorkowski C et al. Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators : results of the REFORM trial. Eur Heart J 2014; 35: 98-105
    CrossrefPubMedGoogle Scholar
  • 39 Piccini JP et al. Impact of Remote Monitoring on clinical events and healthcare utilization: a nationwide assessment. HRS 2015; Abstract LBCT-01-01.
    PubMedGoogle Scholar
  • 40 Cowie MR, Bax J, Bruining N et al. e-Health: a position statement of the European Society of Cardiology. Eur Heart J 2016; 37: 63-66
    CrossrefPubMedGoogle Scholar