ABSTRACT
OBJECTIVES: The primary objective was to determine if wireless remote monitoring with automatic clinician alerts reduces the time from a clinical event to a clinical decision in response to arrhythmias, cardiovascular (CV) disease progression, and device issues compared to patients receiving standard in-office care. A secondary objective was to compare the rates of CV health care utilization between patients in the remote and in-office arms. BACKGROUND: In addition to providing life-saving therapy, implantable cardioverter-defibrillators collect advanced diagnostics on the progression of the patient's heart disease. Device technology has progressed to allow wireless remote monitoring with automatic clinician alerts to replace some scheduled in-office visits. METHODS: The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) study was a multicenter, prospective, randomized evaluation involving 1,997 patients from 136 clinical sites who underwent insertion of an implantable cardioverter-defibrillator (including cardiac resynchronization therapy devices) and were followed up for 15 months. Health care utilization data included all CV-related hospitalizations, emergency department visits, and clinic office visits. RESULTS: The median time from clinical event to clinical decision per patient was reduced from 22 days in the in-office arm to 4.6 days in the remote arm (p < 0.001). The health care utilization data revealed a decrease in mean length of stay per CV hospitalization visit from 4.0 days in the in-office arm to 3.3 days in the remote arm (p = 0.002). CONCLUSIONS: Wireless remote monitoring with automatic clinician alerts as compared with standard in-office follow-up significantly reduced the time to a clinical decision in response to clinical events and was associated with a significant reduction in mean length of CV hospital stay. (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision [CONNECT]; NCT00402246).
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiovascular Diseases/therapy , Decision Making , Telemetry , Aged , Arrhythmias, Cardiac/diagnosis , Cardiac Pacing, Artificial , Cardiovascular Diseases/diagnosis , Decision Support Techniques , Defibrillators, Implantable , Female , Humans , Intention to Treat Analysis , Length of Stay , Male , Middle Aged , Time FactorsABSTRACT
BACKGROUND: Indications for implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators have greatly expanded in the last 5 years, encompassing a wider variety of patients with a multitude of comorbidities. To meet the needs of these patients, the managing clinicians need to streamline their follow-up care. New ICD/cardiac resynchronization therapy defibrillators provide enhanced device status and disease progression remote monitoring capabilities that support more comprehensive and efficient follow-ups. In addition, this monitoring between follow-ups is likely to impact health care utilization. METHODS AND RESULTS: The Clinical evaluation Of remote NotificatioN to rEduCe Time to clinical decision (CONNECT) study will randomize approximately 2,000 patients implanted with an ICD with or without CRT capabilities from 150 sites in the United States to remote monitoring versus standard in-office care. This study will evaluate the time from clinical event to clinical decision in response to the event, as well as the associated impact on health care utilization and quality of life. Patients monitored remotely will be provided a home monitor for transmitting device diagnostics to the clinician's office. These devices will use wireless telemetry, allowing the automatic transmission of diagnostics to the office without the need for patient intervention. Patients receiving in-office care will be followed in the office at a fixed schedule and without remote monitoring. All patients will be followed for 15 months postimplant. CONCLUSION: The CONNECT study is evaluating the impact of remote monitoring and early notification using wireless telemetry on the time to clinical decisions, the allocation of health care utilization, and quality of life. Results from this study are expected mid-2009.
Subject(s)
Cardiac Pacing, Artificial , Defibrillators, Implantable , Telemedicine , Humans , Time FactorsABSTRACT
BACKGROUND: Eye tracking is an accurate and objective means of measuring an instrument scan pattern. The purpose of this study was to determine if prior aircraft experience, phase of flight, and autopilot mode modified the instrument scan pattern of F-117A pilots. METHODS: There were 23 F-117A pilots, grouped by prior aircraft experience, who flew an instrument approach manually and with autopilot while wearing an El Mar eye tracker in the F-117A simulator at Holloman AFB, NM. Number of fixations, dwell time, and percent total dwell time spent on nine individual instruments were collected and analyzed. RESULTS: The primary flight instrument was determined on the basis of pilot experience, and usage of the primary flight instrument varied significantly with phase of flight and manual vs. autopilot when ANOVA analysis was performed. CONCLUSIONS: Prior aircraft experience affects development of an instrument scan in a new aircraft. Prolonged dwell times on the primary flight instrument and changes in fixations/dwell time during autopilot mode have implications for instrument and cockpit design as well as cognitive load during novel situations. Further studies should be pursued.
