Telemedicine for Management of Implantable Defibrillators
Lessons Learned and a Look Toward the Future
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See Article by Dalouk et al
For decades, the field of cardiology has attempted to tackle the complex problem of providing care during critical periods between clinic visits or hospitalizations. Heart failure has been the prototypical disease for which to develop these interventions because care is complex and guided by subtle symptoms and signs of congestion and volume overload. Failure to make ongoing small but clinically significant titrations in heart failure medications was thought to increase risk of heart failure hospitalization and possibly mortality. Therefore, stakeholders sought to develop outside-the-office interventions to manage these patients.
In patients with implantable cardioverter-defibrillators (ICD), optimal management requires yet another layer of oversight, which is device management. Clinical evaluation of the ICD includes assessment of a range of programmed parameters, diagnostics, and tests well known to this readership. In addition, the device visit serves as an opportunity for nurses, nurse practitioners, physicians, and other clinical staff to assess overall and cardiovascular health and social history, which may lead to interventions beyond device therapy, including medication titration, diagnostic testing, and even timely referral to other specialty or primary care physicians. Despite the advent of home-based remote monitoring of cardiac implantable devices, periodic face-to-face visits are still considered essential in clinical practice guidelines, owing to the fact that devices cannot be programmed remotely. For patients and caregivers with difficulty accessing face-to-face care such as those from rural areas, this paradigm may pose challenges or inconveniences for clinic visits that may be perceived as routine or insignificant.
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