RPM-CIED – Remote Patient Management for Cardiac Implantable Electronic Devices

CANet > CANet Newsroom > RPM-CIED – Remote Patient Management for Cardiac Implantable Electronic Devices

There are currently 120 000 Canadians living with either a pacemaker or implantable defibrillator (ICD). Pacemakers are placed into the chest of patients 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 of patients’ hospital visits down to once a year. But 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 centre. This new technology would allow devices to be followed remotely, but also have adjustments made remotely. Patients who don’t live near a major centre would receive the same quality and quantity of care as patients who are living close to such centres. This would have a major impact on patients because they would not be required to travel long distances for care of their devices, nor would there be long delays in receiving highly specialized care in the case of an emergency. This would affect the hospital system because 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.
We are proposing to first perform a survey to better understand the attitudes of patients, device clinic health care professionals, and government regarding the current and new technology. This survey will be performed in device clinics across the country and will target patients, physicians, nurses and technicians. We will also organize a one day meeting called the Knowledge Exchange Meeting, where representatives from industry, government, patients and physicians will come together to identify issues related to the use of this new technology.
We will then propose a study that will take the first look at how well this new technology might work in looking after patients with pacemakers/ICDs. This study will be done in 8 centres across Canada with 400 patients involved. This study will collect important information on how safe, effective and feasible this technology might be. Cost and how it affects the patients’ quality of life will be considered.
The information gathered from these two projects will be used to figure out how to use this new technology across Canada and to test it in a larger study that will tell us whether this new way of following patients with devices is better than what we are doing now. Patients will be randomly placed into one of two groups:  how care is being delivered now, or care using the new technology.
The final project will be dedicated to ensuring that the new technology is implemented and used across device clinics in Canada. In addition, new technology will be explored to make device follow-up easier, with exploration of a platform that can be used commonly among the different companies that make the pacemakers and ICDs that we use in Canada.
 
Program Lead:
Dr. Ratika Parkash
Dalhousie University

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