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- Implantable defibrillator
- implantable cardioverter defibrillator (ICD)
- delivery of care
The prospect of telemedicine has for many decades been an inspiration for science fiction writers. Over recent years, however, reality has caught up with imagination. Technological progress in the field of device follow-up has been fast, changing from transtelephonic and limited evaluation of implanted pacemakers to extensive, daily, wireless transmissions of different kinds of devices without the need for any active involvement by the patient or physician. Patients are embracing the prospect of personalised care and permanent monitoring. Rapidly, remote monitoring will evolve from a fanciful possibility into a necessity. This article will briefly present the current technology, but will mainly focus on the hurdles towards broad and effective implementation in the cardiology clinic.
Telemonitoring: who is waiting for it?
Many parties see benefits in the development of telecardiology. Hospitals and physicians are confronted with an expanding number of patients with devices. This patient population has become more complex, since many have multiple chronic diseases. Also the devices have become increasingly more complex and require time consuming follow-up. Telemedicine is especially attractive in settings of chronic conditions that need to be followed up constantly. Remote monitoring will evaluate not only device functionality but also an ever-expanding spectrum of disease and patient related parameters. Atrial fibrillation and heart failure are typical examples, but evaluation of diabetic control, pulmonary function, and others may follow. For physicians and hospitals therefore there is an opportunity to improve performance, by following up more patients needing more complex chronic care. Remote monitoring also has the potential for improving care, due to earlier diagnosis of device and patient related problems, preventing admissions or further clinical deterioration. Also payers for healthcare are interested in the technology, since it may improve the cost effectiveness of their expenditures for these patient groups. Finally, patients not only seem to be open to telemedicine, but positively embrace it. …
Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. The author is: holder of the AstraZeneca Chair in Cardiac Electrophysiology, University of Leuven; has received research funding through the University of Leuven from Siemens Medical Solutions; is Coordinating Clinical Investigator for the Biotronik-sponsored EuroEco study on health-economics of remote device monitoring; is a member of the scientific advisory board of Biosense Webster, Inc, St Jude Medical, Inc, Siemens Medical Solutions, Boehringer-Ingelheim, Bayer and Sanofi-Aventis; and receives unconditional research grants through the University of Leuven from St Jude Medical, Medtronic, Biotronik and Boston Scientific Inc.
Provenance and peer review Commissioned; not externally peer reviewed.