| Objective: To explore the clinical value of telemedicine in follow-up management after implantable pacemaker implantation.Methods: Patients with atrioventricular block or sick sinus syndrome diagnosed in subei people's hospital from January to December 2018 and hospitalized for pacemaker implantation were randomly divided into a routine follow-up group and a remote followup group for a 12-month clinical follow-up study.In the routine follow-up group,the patients in the remote follow-up group were followed up with mobile phone app in 3 months and 9 months after operation,and the patients in the remote follow-up group were followed up with the mobile phone app in addition to the routine follow-up in 1 month,6 months and 12 months after operation.Meanwhile,the patients in the non follow-up period could contact the follow-up doctors for medical help in time if they were not in time..At the same time,the patients in the non follow-up period could contact the followup doctors for medical help through mobile APP.During the follow-up,patients in the remote follow-up group communicated with the doctor through the mobile APP,and the doctor gave corresponding medical advice.After the end of the follow-up,the follow-up status and the feedback on the use of mobile APP were counted,and the health education effect,quality of life,medication compliance,anxiety score,pacemaker programmed parameters,postoperative complications and other adverse events of the two groups were compared.Results: At the beginning of this study,a total of 271 patients with cardiac pacemaker implantation were enrolled,and they were randomly divided into the remote follow-up group and the routine follow-up group,of which 1 case was lost to follow-up in the remote follow-up group and 8 cases were lost to follow-up in the routine follow-up group.At the end of the study,a total of 262 patients completed the follow-up study,129 in the remote follow-up group and 133 in the conventional follow-up group.Outpatient follow-up was completed for a total of 713 times,including 608 expected outpatient visits and 105 unexpected outpatient visits.In the expected outpatient service,236 times of pacemaker implantation occurred in the first month,of which 49.2%(116 / 236)were in the remote follow-up group,50.8%(120 / 236)in the routine follow-up group,204 times in the six months after pacemaker implantation,53.4%(109 / 204)in the remote follow-up group,46.6%(95 / 204)in the routine follow-up group,168 times in the 12 months after pacemaker implantation,58.9%(99 / 168)in the remote follow-up group,the routine follow-up group accounted for 41.1%(69 / 168).There were 105 unexpected outpatient visits,34.3%(36 / 105)in the remote follow-up group and 65.7%(69 / 105)in the routine follow-up group.In the remote follow-up group,app was used for 240 times in total,112 times after pacemaker implantation in 3 months,102 times in 9 months,and 26 times of unexpected app follow-up,of which 62.9%(151 / 240)suggested that patients change their lifestyle or comfort their anxiety,29.2%(70 / 240)suggested that patients adjust their oral medication,and 7.9%(19 / 240)suggested that they come to the clinic for further treatment in the near future.90.7% of the patients were satisfied with the remote follow-up after pacemaker implantation.There was no significant difference between the two groups at baseline(7.76 ± 1.28,7.84 ± 1.16,P > 0.05),and at the end of follow-up(10.03 ± 0.96,9.64 ± 0.94,P < 0.05).There was no significant difference in the quality of life score between the two groups at baseline(0.64 ± 0.13 vs 0.63 ± 0.11,P > 0.05).At the end of follow-up,there was a significant difference in the score(0.79 ± 0.04 vs 0.77 ± 0.05,P < 0.05).At the baseline level,there was no significant difference in the mean score of anxiety scale between the two groups(8.38 ± 3.57 vs 8.44 ± 3.28,P > 0.05).At the end of follow-up,there was a significant difference between the two groups(5.09 ± 1.65 vs 5.58 ± 2.05,P < 0.05).There was no significant difference between the two groups at baseline(P > 0.05)and at the end of follow-up(P < 0.05).There was no significant difference in the incidence of postoperative complications,secondary operation and readmission between the two groups(P > 0.05).The median delay time of medical intervention in the precise follow-up group and the routine follow-up group was statistically significant[2.5(1.8,4.8)vs 12.0(7.0,60.0),P<0.05].Conclusion: 1.It is feasible to use mobile phone application,wearable dynamic electrocardiogram and outpatient service to carry out telemedicine follow-up for patients after implantable pacemaker operation,which can improve the knowledge of pacemaker and related chronic diseases,and the patients have a high degree of acceptance and satisfaction with this follow-up mode.2.The use of remote follow-up can achieve the effective management of postoperative patients' individualization,increase follow-up compliance,early identify complications and deal with them in time.Remote follow-up can reduce some unnecessary outpatient visits and increase the compliance of patients with chronic diseases,so as to improve the quality of life. |
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