Walfare continuity to the patient after the implantation of a

cardiac electronic device

Background

.

The electronic implantable cardiac devices (ICD) are used for the treatment of diseases such as bradycardia, tachycardia, heart failure (HF) as well as for the tracking of arrhythmias. The monitoring of the patient, of the disease, and of the device is crucial for the detection of any clinical problem or any problem related to the device itself.

Impiantable Cardioverter Defibrillator

In order to verify the correct functioning of the devices, a periodic follow-up is generally carried on with outpatient monitoring at intervals of 3 - 12 months. The increase in the number of implanting procedures and the proportional increment in the number of controls are intended to impose to the cardiac health facilities an increasingly higher amount of work. Furthermore, outpatient controls of the device carried on after the implantation constitute a condition of discomfort for the patient due to both the psycho-physical stress (considering the high average age of the patients) and the anxiety that may rise from the lack of monitoring in the time windows between a control and the next. As of today in Italy there is a lack of experience with respect to a 24 hours on 24 monitoring service. Observational records prove that a remote control of the patient is associated with a reduced risk of mortality.

Implantable Loop Recorder

R. Cervellione (Author), G. Bucca (Author), M. Moro

U.O. di Elettrofisiologia e Cardiostimolazione - Centro Cardiologico Monzino IRCCS, Milan, Italy

L. Barbieri*, F. Bonfiglio*, R. Fasana*, M. La Notte*, S. Parigi*, C. Perlotti*, A. Somenzi*, M. Vendramin*, C. Franzoni**, G. Pensa** * U.O. di Elettrofisiologia e Cardiostimolazione – Centro Cardiologico Monzino IRCCS, Milan, Italy; **Medtronic Italia

Method

The organizational set-up will be structured to ensure a 24 hours a day functioning. A proper organization for the correct system functioning implies a rigorous and precise definition of tasks and responsibilities of the professionals involved. The process is composed of 5 operational phases: Phase 1. Patient registration. Phase 2. Educational training of the patient. Phase 3. Phone assistance (24/24h): analysis of the transmitted data

following patient signalling. Phase 4. Analysis of the transmitted data and alert check. Phase 5. Outpatient follow-up and remote control. Thanks to the dedicated device, Medtronic CareLink® Monitor, the patient has the possibility to transmit from his residence through the analogical phone line his electrocardiographic data in case of: a) Scheduled follow-up visits: data related to the cardiac implant and lead. b) Symptomatic or post-shock events. c) Alarms related to the defibrillator’s status.

1 month

6 months

Device’s routin checks, from

your HOME

Clinical checks

12 months

Follow Up

Device

Implantation

Clinical

Check Check of

the Device

Training pre – hospital discharge

4 months

Monitor CareLink

Goals

Implementation of the business service in order to monitor, remotely, a patient with ICD working 24/24 h, that allows to: •Improve the patient’s life quality. •Rationalize resources and decrease costs. •Reduction of waiting lists and reducing unnecessary access to the emergency room.

Outcomes

Benefits for the patient:

• Decreased anxiety linked to the device implantation.

• Improving the patient satisfaction / perceived quality, related to the

provision of health received.

• Improving the quality of life / well-being of the patient.

• Early identification of technical problems (ICD, lead).

• Ongoing assessment of the status of the battery.

• Early identification of changes in clinical status of the patient.

• Reduction of economic costs involved in the movement.

Benefits for the organization:

• Reduction and optimization of outpatient controls.

• Reduction of costs related to the management of ambulatory patients.

• Reduction of access to the emergency room without real reasons of

urgency / emergency.

• Increase the skills and motivation of the professionals involved.

• Increase the attractiveness / competitiveness.