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Importance of Education in the Care of Patients with Implantable Cardioverter-Defibrillators with the Possibility of Remote Monitoring
ŠAFAŘÍKOVÁ, Iva
Remote monitoring is a type of telemedicine for patients with implantable cardioverter-defibrillators (ICDs) that has already become the standard of care; however, it requires more efficient methods of patient education. The main goals of our study were to determine the current level of knowledge of patients with ICDs regarding the use of remote device monitoring and determine if an intensive education program would be beneficial for ICD patients. 163 patients (122 men, 41 women, mean age 64?77 years) in whom a single chamber, dual chamber, or biventricular ICDs were implanted in 17.8%, 5.5%, and 76.7%, respectively, were included in the trial and followed using the Home Monitoring? (HM) system (Biotronik, Germany). Patients were randomized either into a group with standard physician-led education program (control group) or into a group with an intensive nurse-led educational program using in-person content, along with written and video material (intervention group). All education sessions were carried out during the primary hospitalization. Enrolled patients were approached the day after ICD implantation with the request to fill in a detailed questionnaire (baseline), which investigated the general and technical knowledge as well as the patient?s awareness of the clinical advantages of using an HM system. After three months of follow-up, both groups of patients were surveyed again, using the same questionnaire with the same questions. Using a different questionnaire, patient satisfaction with the provided education programs was also surveyed. Furthermore, patient opinions regarding adding a nurse educator position to daily clinical practice were also assessed.The day after ICD implantation, we found that patients had little understanding of the ICD type they had received and poorly understood the advantages of remote monitoring of their device. After the three-month follow-up, 100% of the nurse-educated group vs. 44% of the control group had a good understanding of the follow-up possibilities of their ICD (p<0.001). Altogether 88% of nurse-educated group vs. 59% of control group were able to correctly define the term ?telemedicine? (p<0.001) and the former group also demonstrated a better understanding of remote monitoring (p<0.001).The technical functions of patient units (i.e., the CardioMessengers) were also better understood by the educated vs. control group (p<0.001). Patients in the nurse-led education group were able to list and describe more clinical advantages of remote ICD monitoring than the control group (p<0.001). Regarding patient satisfaction with HM information, educated patients were more satisfied with all types of education than patients in the control group (p<0.001). Most patients assessed the educational video positively, with a mean grade of 1.2 ? 0.7 on a scale from 1 (best) to 5 (worst). The vast majority (97%) of patients, undependently of the educational program group, reported that they would ?definitely? or ?most likely? welcome receiving information on remote monitoring of their ICD devices from a qualified nurse-educator as part of routine clinical practice.Intensive education of patients regarding remote monitoring of their ICDs contributes to better overall technical knowledge of the HM system and a better understanding of telemedicine in general. It also leads to greater awareness regarding the clinical advantages of HM. However, patients not in the nurse-led education program reported that they were not satisfied with the remote monitoring education they received; most of these patients reported that they would also prefer an intensive education program led by a qualified nurse as part of routine in-hospital education regarding HM devices. Therefore, we recommend creating a nurse-led educational program in telemedicine (i.e.,remote monitoring care) for ICD patients. Such a program would guarantee the provision of timely and accurate information for ICD patients and their families.
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Quality of life of patients with cardiac implants followed by remote monitoring systems.
ŠAFAŘÍKOVÁ, Iva
Abstract Introduction: The perception of quality of life (QoL) in patients with implantable cardiac devices including implantable cardioverter-defibrillators (ICD), followed by telemonitoring care (Home Monitoring HM), has recently become an extremely hot topic due to constantly increasing number of patients wearing these devices. This increase has resulted in an increased demand for safe, prompt, and more effective out-patient care. Methods: Our research was carried out between December 2016 and March 2017. A cohort of 150 consecutive patients with ICD, followed using the Home Monitoring system (HM+), and 150 consecutive patients with ICD, followed using conventional in-office check-ups (HM-), was retrospectively drawn from the Ceske Budejovice Hospital Patient Information System. A questionnaire, which specifically addressed QoL (EQ5D), level of anxiety and depression (HADS), and a custom questionnaire examining the relationship between patients and the HM system and telecare workflow, was sent out to all patients. Results: For the final statistical analysis, 91 (60.7%) and 104 (69.3%) of the questionnaires were used from the HM+ and HM- groups, respectively. Our results showed that the method of ICD device follow-up did not directly influence QoL. Our statistical comparison of the data did not show any difference between HM+ and HM- patients. A non-significant trend towards better QoL in HM+ compared to HM- patients was noted based on total QoL scores from the EQ5D questionnaire (68.6 ? 19 vs. 64.6 ? 16.5, p = 0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM- patients. However, more than half of the patients in both groups were in the "normal" population range with respect to anxiety and depression. The most striking difference between HM+ and HM- patients was noted in the preference for the type of follow-up: while 54.9% of HM- patients expressed an interest in remote follow-up and 45.1% said they preferred in-office check-ups, only 6.7% (p < 0.0001) of HM+ patients expressed an interest in switching to in-office check-ups with personal contact instead of remote monitoring. Willingness to partially cover the financial costs of telecare was similar in both groups. HM+ patients were more inclined to use remote ICD monitoring (p = 0.007) and had a more positive attitude toward the telecare approach overall, compared to HM- patients (p = 0.034). Conclusion: The method of device follow-up does not significantly affect QoL in patients with ICD devices, nor does it affect levels of anxiety and depression. Generally, patients with ICDs followed using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring. Although, the willingness to, at least partially, cover the costs of the HM system was limited and comparable to that of patients receiving conventional follow-up.
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