| Background:Heart failure is the final clinical outcome of various organic heart diseases.With the worsening of aging in China,heart failure has become a disease of high incidence and high fatality rate.Statistically,morbidity of heart failure in China is 0.9%and total population with heart failure is over 12 million people.Patients of heart failure are admitted for repeated treatment due to aggravated symptoms,with 25%patients returning to hospital within one month after discharge and 50%returning to hospital within six months after discharge.At present,some pacemakers can carry out continuous and remote monitoring of patients for parameters reflecting heart failure,such as average heart rate,heart rate during rest and activities of patients in 24 hours.Meanwhile,VT/VF incidents can be recorded and data can be transmitted in time.Objective:This study aims to assess whether remote monitoring for off-hospital management can improve prognosis for patients with heart failure compared with traditional follow-up method.Method:Patients with heart failure who have been implanted with cardiac electronics in Gulou hospital from July 2014 to July 2016 are screened and are divided into remote monitoring set and conventional follow-up set.The research ends six months after the last patients set is included.All patients return to hospital for follow-ups within one month,six months and 12 months after surgery,and then once a year for follow-ups.Apparatus testing and program control are carried out for every follow-up patient.Phone calls are made to master patients’ state for those who are unable for in-time follow-up.All patients are informed that timely consultation shall be done in case of electric shock and heart failure worsening.For those in other places,we recommend that they contact physicians in charge of follow-up through calls.All electric shock,heart failure worsening,and clinical intervention measures shall be on the record as original file.Monitoring data for remote monitoring set will be uploaded to the Internet and patients will be contacted immediately and related intervention measures will be offered in case of alarms indicating heart failure worsening.Result:37 cases are included in remote monitoring set,among which 17 ICD,20 CRT-D,28 male cases and 19 female cases with average age being 67.7±11.2.9 patients undergo heart failure worsening for 34 times,among which 7 patients are hospitalized for 17 times in total.40 cases are included in the conventional follow-up set as comparison,among which 15 ICD,25 CRT-D,29 male cases and 11 female cases with average age being 65.6±10.8.16 patients are hospitalized for 33 times.Readmission rate in remote monitoring set is reduced by 21.1%(P<0.05)compared with conventional follow-up set.Readmission rate for patients of NYHA class III in remote monitoring set is reduced by 30.3%(P<0.05)compared with conventional follow-up set.261 VT and 15 VF incidents occur in remote monitoring set,among which 24(9.2%)VT and 4 VF(26.7%)are due to error identification of the apparatus.152 VT and 26 VF incidents occur in conventional follow-up set,among which 10 VT(6.6%)and 8 VF(30.8%)are due to error identification of the apparatus.Diagnosis time for 14 patients of VT/VF in remote monitoring set is 2.88±1.73 days and that for 13 patients of ICD in conventional follow-up set is 37.09±26.67 days.Diagnosis time for VT/VF in remote monitoring set is reduced by 34.21±20.36 days compared with conventional follow-up set.Conclusion:Remote monitoring of parameters such as average heart rate,heart rate during rest and activities of patients in 24 hours and in-advance intervention will reduce the readmission rate for patients of aggravated symptoms.Diagnosis time for VT/VF is obviously lowered in remote monitoring set compared with conventional follow-up set. |
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