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Outcomes of Telemedicine Video-Conferencing Clinic Versus In-Person Clinic Follow-Up for Implantable

Khidir Dalouk1, Nainesh Gandhi2, Peter Jessel2

  • 1From the Knight Cardiovascular Institute (K.D., N.G., P.J., K.M., I.G.Z., M.R.), Biostatistics and Design Program (M.L.), Oregon Clinical & Translational Research Institute (OCRTI), Oregon Health and Science University, Portland; and Electrophysiology Department, Portland Veterans Affairs Medical Center, OR (P.J., K.M., I.G.Z., M.R.). dalouk@ohsu.edu.

Circulation. Arrhythmia and Electrophysiology
|September 17, 2017
PubMed

Insights

Telemedicine video-conferencing clinic (TMVC) follow-up for implantable cardioverter-defibrillator (ICD) patients is as effective as conventional in-person clinic (CIC) follow-up. This approach improves access to care for patients in remote areas.

Area of Science:

  • Cardiology
  • Telemedicine
  • Health Services Research

Background:

  • Implantable cardioverter-defibrillator (ICD) recipients require regular follow-up.
  • Long-distance travel for clinic visits poses challenges for patients.
  • Telemedicine offers a potential solution to improve accessibility of care.

Purpose of the Study:

  • To compare clinical outcomes between ICD patients managed via telemedicine video-conferencing clinic (TMVC) and conventional in-person clinic (CIC).
  • To determine if TMVC follow-up is noninferior to CIC follow-up.

Main Methods:

  • Retrospective study comparing outcomes in TMVC and CIC groups (2001-2016).
  • Outcomes assessed include time to first appropriate/inappropriate ICD therapy, time to first shock, and overall survival.
  • Statistical analysis included adjusted and unadjusted noninferiority tests.

Main Results:

  • 287 patients in TMVC group, 236 in CIC group.
  • No significant differences in age or Seattle heart failure model scores between groups.
  • Higher Charlson comorbidity index in CIC group (P=0.01).
  • TMVC follow-up was found to be noninferior to CIC follow-up for all prespecified outcomes.

Conclusions:

  • Telemedicine video-conferencing provides noninferior outcomes for ICD follow-up compared to in-person visits.
  • This approach is particularly beneficial for patients in areas lacking electrophysiology subspecialty care.
Abstract

Keywords:
comorbiditydefibrillators, implantablefollow-up studiesheart failureshock

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