Role and Prospective of Remote Monitoring in Management of Patients with Cardiac Implantable Devices

摘要

Many studies have now shown that remote control of implantable devices (Home Monitoring, HM) is beneficial for the patient, making very strict and custom controls, allowing an earlier identification of potential problems and avoiding unnecessary visits. HM is also beneficial for the hospitals, which reduce progressively the resources used in routine checks, often not necessary, instead dedicating resources to the management of critical patients in the moment in which real clinical problems arise. According to the current guidelines Italian and European HM can replace the standard ambulatory monitoring, thereby reducing the amount of outpatient visits to be made in the individual patient (instead of testing every 6 months, it is possible to schedule one annual overall clinical evaluation of the patient, while intermediate checks are performed by remote transmissions. To date however, HM, although recommended by the Italian and European guidelines, do not yet have a specific reimbursement charge within the NHS and therefore HM cannot be carried out as an institutional activity within the hospital. Furthermore, many critical issues must yet be resolved before a full utilization of HM system can be used for the clinical management of patients, particularly in patients with heart failure at higher risk of cardiac death.