医学
心力衰竭
急诊科
急诊医学
医疗保健
心脏再同步化治疗
医疗急救
随机对照试验
生活质量(医疗保健)
植入式心律转复除颤器
临床终点
入射(几何)
内科学
射血分数
物理
护理部
精神科
光学
经济
经济增长
作者
Maurizio Landolina,Giovanni Battista Perego,Maurizio Lunati,Antonio Curnis,Giuseppe Guenzati,Alessandro Vicentini,Gianfranco Parati,Gabriella Borghi,Paolo Zanaboni,Sergio Valsecchi,Maurizio Marzegalli
出处
期刊:Circulation
[Ovid Technologies (Wolters Kluwer)]
日期:2012-06-19
卷期号:125 (24): 2985-2992
被引量:300
标识
DOI:10.1161/circulationaha.111.088971
摘要
Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits.This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; P=0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; P<0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (P<0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (P=0.026).Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873899.
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