There are currently 120 000 Canadians living with either a pacemaker or implantable defibrillator (ICD). Pacemakers are placed into the chest of a patient who needs their heartbeat to be supported. ICDs are devices that can deliver a life-saving shock to someone who already has had a dangerous heart rhythm, or is at risk of developing one. All of these devices need to be followed on a regular basis by physicians, nurses or technicians who understand how they work so that the chance of malfunction is very low. As these devices are machines, they are also prone to recall and may require close monitoring to avoid the risk of malfunction. Currently, patients who have these devices are required to visit a clinic at least twice a year, sometimes more frequently if their device has been recalled or if other problems are experienced, such as a shock from their ICD, which occurs infrequently but requires urgent assessment.
Technology is available to allow remote monitoring of these devices, reducing the burden to patients insofar as they only need to visit a hospital once a year for this purpose. Now, there is even newer technology that could completely remove the need for patients to travel outside of their local community to receive care from a highly specialized device center. This new technology would allow devices to be followed remotely, with direct knowledge of this follow up going back to the patient. Patients who don’t live near a major center would receive the same quality and quantity of care as patients who are living close to such centers. This would have a major impact on patients in that they would not be required to travel long distances for care of their device, nor would there be long delays in receiving highly specialized care in the case of an emergency. This would affect the hospital system as device clinics would no longer be faced with long wait times for patients, overcrowding and lack of resources.The large numbers of patients that currently have devices in Canada will feel the impact of this program.
The two projects proposed in this application are dedicated to measuring how well this new approach to following patients works. We plan to perform two randomized clinical trials, one in patients with implantable defibrillators and the other in patients with pacemakers alone. Each of these trials will determine if the novel technology is safe, effective and reduces cost and improves quality of life for patients. We plan to then develop this technology further to include automation in terms of interpretation of the remote monitoring information received from patients as well as expanding the use of VIRTUES, the novel technology being tested in this proposal.
Dr. Ratika Parkash MD, FRCPC
Dr. Ratika Parkash is an outcomes and clinical trials researcher in atrial fibrillation and cardiac implantable electrical devices. Dr. Parkash was previously Chair of the Canadian Heart Rhythm Society Device Committee and, as such, led research on Riata (St Jude Medical) in Canada. The retrospective survey on Riata was accepted for publication in Heart Rhythm in 2013.
Dr. Parkash is the principle investigator and main author of Atrial Substrate Modification With Aggressive Blood Pressure Lowering to Prevent AF, a CIHR-funded, multi-center clinical trial examining the use of aggressive blood pressure lowering in patients undergoing catheter ablation for atrial fibrillation. She is also co-investigator of IMPACT-AF.