Introduction All patients with a cardiac pacemaker require regular routine follow up. At an interval of no greater than twelve months battery longevity and lead parameters require assessment. This is usually undertaken in secondary care, by a trained cardiac physiologist, in a clinic setting. At University Hospital Southampton 2878 patients undergo routine pacemaker follow up. Pacemaker prevalence increases with patient age. Many patients with pacemakers are frail with multiple co-morbidities and a high percentage are reliant on hospital transport. Hospital attendance for this cohort can be challenging and costly. The pacemaker clinic has a high DNA (did not attend) rate. In 2012, 285 appointment slots were not utilised (around 15% of total appointments).
Two-thirds of our pacemaker patients have a remote compatible Medtronic device. A single Medtronic carelink express monitor, placed in a convenient community location, would allow multiple patients to undergo remote monitoring. We hypothesise that this would increase patient satisfaction with pacemaker follow up, reduce wasted appointment time, minimise expenditure on hospital transport, decrease carbon footprint, and increase availability of on-site clinics and physiologists. We hypothesise that this would be a safe and effective method of conducting pacemaker follow up.
Method A Medtronic carelink express monitor was placed in a community health centre and a pilot group of 90 patients were invited to partake in community follow up. Patients were instructed on how to use the monitoring device and 57 patients were successfully enrolled. Patients were given an indication of when pacemaker follow up was required, but exact attendance time was entirely at their discretion. The carelink monitor was unmanned. Information was sent wirelessly to the hospital and assessed at a virtual follow up clinic.
Results 100% of patients successfully utilised the remote device with a virtual DNA rate of 0%. No patients required extra assistance in using the equipment at the time of download. The average time to assess a download was 6 min, compared to 15 min for an on-site appointment. There were no adverse events during the follow up period. Average patient travel time and distance for follow up was reduced. Hospital transport was not required for any patient. The feedback from patients was positive and based around ease of travel, length of travel and stay, and flexibility to attend.
Conclusions and Implications This pilot study demonstrates the feasibility and benefits of remote pacemaker monitoring from a community location. This model could be replicated in the future by other Trusts.
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