TY - JOUR
T1 - Remote monitoring and clinical outcomes
T2 - details on information flow and workflow in the IN-TIME study
AU - Daniela, Husser
AU - Christoph, Geller
AU - Miloš, Taborsky
AU - Rolf, Schomburg
AU - Frank, Bode
AU - Jens Cosedis, Nielsen
AU - Christoph, Stellbrink
AU - Meincke, M. D.
AU - Hjortshøj, Søren Pihlkjær
AU - Schrader, J
AU - Lewalter, T
AU - Hindricks, G
N1 - © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2019/4
Y1 - 2019/4
N2 - Aims Randomized clinical trials investigating a possible outcome effect of remote monitoring in patients with implantable defibrillators have shown conflicting results. This study analyses the information flow and workflow details from the IN-TIME study and discusses whether differences of message content, information speed and completeness, and workflow may contribute to the heterogeneous results. Methods and results IN-TIME randomized 664 patients with an implantable cardioverter/defibrillator indication to daily remote monitoring vs. control. After 12 months, a composite clinical score and all-cause mortality were improved in the remote monitoring arm. Messages were received on 83.1% of out-of-hospital days. Daily transmissions were interrupted 2.3 times per patient-year for more than 3 days. During 1 year, absolute transmission success declined by 3.3%. Information on medical events was available after 1 day (3 days) in 83.1% (94.3%) of the cases. On all working days, a central monitoring unit informed investigators of protocol defined events. Investigators contacted patients with a median delay of 1 day and arranged follow-ups, the majority of which took place within 1 week of the event being available. Conclusion Only limited data on the information flow and workflow have been published from other studies which failed to improve outcome. However, a comparison of those data to IN-TIME suggest that the ability to see a patient early after clinical events may be inferior to the set-up in IN-TIME. These differences may be responsible for the heterogeneity found in clinical effectiveness of remote monitoring concepts.
AB - Aims Randomized clinical trials investigating a possible outcome effect of remote monitoring in patients with implantable defibrillators have shown conflicting results. This study analyses the information flow and workflow details from the IN-TIME study and discusses whether differences of message content, information speed and completeness, and workflow may contribute to the heterogeneous results. Methods and results IN-TIME randomized 664 patients with an implantable cardioverter/defibrillator indication to daily remote monitoring vs. control. After 12 months, a composite clinical score and all-cause mortality were improved in the remote monitoring arm. Messages were received on 83.1% of out-of-hospital days. Daily transmissions were interrupted 2.3 times per patient-year for more than 3 days. During 1 year, absolute transmission success declined by 3.3%. Information on medical events was available after 1 day (3 days) in 83.1% (94.3%) of the cases. On all working days, a central monitoring unit informed investigators of protocol defined events. Investigators contacted patients with a median delay of 1 day and arranged follow-ups, the majority of which took place within 1 week of the event being available. Conclusion Only limited data on the information flow and workflow have been published from other studies which failed to improve outcome. However, a comparison of those data to IN-TIME suggest that the ability to see a patient early after clinical events may be inferior to the set-up in IN-TIME. These differences may be responsible for the heterogeneity found in clinical effectiveness of remote monitoring concepts.
KW - Defibrillator
KW - Heart failure
KW - Telemedicine
KW - implantatble
KW - Reproducibility of Results
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Remote Sensing Technology/methods
KW - Treatment Outcome
KW - Workflow
KW - Heart Failure/diagnosis
KW - Time Factors
KW - Defibrillators, Implantable
KW - Female
KW - Time and Motion Studies
KW - Monitoring, Ambulatory/methods
UR - http://www.scopus.com/inward/record.url?scp=85063036519&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcy031
DO - 10.1093/ehjqcco/qcy031
M3 - Journal article
C2 - 30016396
SN - 2058-1742
VL - 5
SP - 136
EP - 144
JO - European heart journal. Quality of care & clinical outcomes
JF - European heart journal. Quality of care & clinical outcomes
IS - 2
ER -