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1.
J Clin Med ; 12(2)2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36675547

RESUMO

The feasibility and effectiveness of virtual visits (VVs) for cardiac electrophysiology patients are still unknown. We aimed to assess the feasibility and effectiveness of VVs as compared to in-person visits, and to describe patient experience with virtual care in clinical electrophysiology. We prospectively enrolled patients scheduled to receive a clinical electrophysiology evaluation, dividing them in two groups: a VV group and an in-person visit group. Outcomes of interest were: (1) improvement in symptoms after the index visit, (2) disappearance of remote monitoring (RM) alerts at follow-up, (3) necessity of urgent hospitalization and (4) patient satisfaction measured by the Patient Satisfaction Questionnaire-18 (PSQ-18). This study included 162 patients in the VV group and 185 in the in-office visit group. As compared to in-person visits, VVs resulted in a similar reduction in RM alerts (51.5% vs. 43.2%, p-value 0.527) and in symptomatic patient rates (73.6% vs. 56.9%, p-value 0.073) at follow-up, without differences in urgent hospitalization rates (p-value 0.849). Patient satisfaction with VVs was higher than with in-person evaluation (p-value < 0.012). VVs proved to be as feasible and as effective as in-person visits, with high patient satisfaction. A hybrid model of care including VVs and in-person visits may become the new standard of care after the COVID-19 pandemic is over.

2.
J Interv Card Electrophysiol ; 64(1): 257-264, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35412167

RESUMO

BACKGROUND: The remote device management (RM) is recommended for patients with cardiac implantable electronic devices (CIEDs). RM underutilization is frequently driven by the lack of correct system activation. The MyLATITUDE Patient App (Boston Scientific) has been developed to encourage patient compliance with RM by providing information on communicator setup, troubleshooting, and connection status of the communicator. METHODS: At 14 centers, patients with CIEDs were invited to download and install the App on a mobile device. After 3 months, patients were asked to complete an ad hoc questionnaire to evaluate their experience. RESULTS: The App was proposed to 242 consecutive patients: 81 before RM activation, and 161 during follow-up. The App was successfully installed by 177 (73%) patients. The time required for activation of the communicator and the need for additional support were similar between patients who followed the indications provided by the App and those who underwent standard in-clinic training. During follow-up, notifications of lack of connection were received by 20 (11%) patients and missed transmission by 22 (12%). The median time from notification to resolution was 2 days. After 3 months, 175 (99%) communicators of the 177 patients who installed the App were in "Monitored" status versus 113 (94%) of 120 patients without the App installed (p=0.033). The use of the app made 84% of patients feel reassured. CONCLUSIONS: The App was well accepted by CIED patients and offered support for communicator management and installation. Its use enabled patients to remain connected with greater continuity during follow-up.


Assuntos
Desfibriladores Implantáveis , Aplicativos Móveis , Marca-Passo Artificial , Humanos , Monitorização Fisiológica , Estudos Multicêntricos como Assunto , Cooperação do Paciente
3.
Card Electrophysiol Clin ; 14(1): 125-131, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35221081

RESUMO

During the coronavirus disease 2019 (COVID-19) worldwide pandemic, patients with cardiac implantable electronic device (CIED) refused scheduled follow-up visits because of the risk of infection. In this scenario, different telemedicine strategies have been implemented to ensure continuity of care to CIED patients. Patients can be monitored through dedicated applications, telephone calls, or virtual visits providing easy access to valuable information, such as arrhythmic events, acute decompensation manifestations, and device-related issues, without the need for in-person visits. This review provides a comprehensive description of the many possible applications of telemedicine for CIED patients during the COVID-19 period.


Assuntos
COVID-19 , Desfibriladores Implantáveis , Marca-Passo Artificial , Telemedicina , Eletrônica , Humanos , Pandemias , SARS-CoV-2
4.
Pacing Clin Electrophysiol ; 44(6): 995-1003, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33908052

RESUMO

BACKGROUND: During the COVID-19 pandemic in-person visits for patients with cardiac implantable electronic devices should be replaced by remote monitoring (RM), in order to prevent viral transmission. A direct home-delivery service of the RM communicator has been implemented at 49 Italian arrhythmia centers. METHODS: According to individual patient preference or the organizational decision of the center, patients were assigned to the home-delivery group or the standard in-clinic delivery group. In the former case, patients received telephone training on the activation process and use of the communicator. In June 2020, the centers were asked to reply to an ad hoc questionnaire to describe and evaluate their experience in the previous 3 months. RESULTS: RM was activated in 1324 patients: 821 (62%) received the communicator at home and the communicator was activated remotely. Activation required one additional call in 49% of cases, and the median time needed to complete the activation process was 15 min [25th-75th percentile: 10-20]. 753 (92%) patients were able to complete the correct activation of the system. At the time when the questionnaire was completed, 743 (90%) communicators were regularly transmitting data. The service was generally deemed useful (96% of respondents) in facilitating the activation of RM during the COVID-19 pandemic and possibly beyond. CONCLUSIONS: Home delivery of the communicator proved to be a successful approach to system activation, and received positive feedback from clinicians. The increased use of a RM protocol will reduce risks for both providers and patients, while maintaining high-quality care.


Assuntos
Arritmias Cardíacas/terapia , COVID-19/epidemiologia , Desfibriladores Implantáveis , Serviços de Assistência Domiciliar , Distanciamento Físico , Pneumonia Viral/epidemiologia , Tecnologia de Sensoriamento Remoto/instrumentação , Feminino , Humanos , Incidência , Itália , Masculino , Marca-Passo Artificial , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2
5.
J Cardiovasc Electrophysiol ; 31(11): 2814-2823, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32954600

RESUMO

INTRODUCTION: Remote monitoring (RM) has significantly transformed the standard of care for patients with cardiac electronic implantable devices. It provides easy access to valuable information, such as arrhythmic events, acute decompensation manifestations and device-related issues, without the need of in-person visits. METHODS: Starting March 1st, 332 patients were introduced to an RM program during the Italian lockdown to limit the risk of in-hospital exposure to severe acute respiratory syndrome-coronavirus-2. Patients were categorized into two groups based on the modality of RM delivery (home [n = 229] vs. office [n = 103] delivered). The study aimed at assessing the efficacy of the new follow-up protocol, assessed as mean RM activation time (AT), and the need for technical support. In addition, patients' acceptance and anxiety status were quantified via the Home Monitoring Acceptance and Satisfaction Questionnaire and the Generalized Anxiety Disorder 7-item scale. RESULTS: AT time was less than 48 h in 93% of patients and 7% of them required further technical support. Despite a higher number of trans-telephonic technical support in the home-delivered RM group, mean AT was similar between groups (1.33 ± 0.83 days in home-delivered vs 1.28 ± 0.81 days in office-delivered patients; p = .60). A total of 28 (2.5%) urgent/emergent in-person examinations were required. A high degree of patient satisfaction was reached in both groups whereas anxiety status was higher in the office-delivered group. CONCLUSIONS: The adoption of RM resulted in high patient satisfaction, regardless of the modality of modem delivery; nonetheless, in-office modem delivery was associated with a higher prevalence of anxiety symptoms.


Assuntos
COVID-19/prevenção & controle , Estimulação Cardíaca Artificial , Cardioversão Elétrica/instrumentação , Cardiopatias/terapia , Marca-Passo Artificial , Tecnologia de Sensoriamento Remoto , Telemedicina , Idoso , Idoso de 80 Anos ou mais , COVID-19/transmissão , Desfibriladores Implantáveis , Cardioversão Elétrica/efeitos adversos , Estudos de Viabilidade , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese
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