Related Experiment Videos
Diagnostic and cost effectiveness of telemonitoring the pediatric pacemaker patient
J A Vincent1, D L Cavitt, P P Karpawich
1Section of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
Insights
Routine telephone monitoring (TM) for pediatric pacemaker patients in the US is effective and cost-saving. While patient-reported symptoms have low accuracy, TM reliably detects asymptomatic pacemaker issues, improving patient care.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Comprehensive pacemaker follow-up protocols often include telephone monitoring (TM).
- The diagnostic and cost-effectiveness of routine TM in pediatric patients in the United States remains largely unknown.
- Pediatric patients present unique challenges due to age, size, and symptom correlation difficulties.
Purpose of the Study:
- To evaluate the diagnostic and cost-effectiveness of routine telephone monitoring (TM) in pediatric patients with pacemakers.
- To assess the reliability of TM in detecting pacemaker dysfunction and dysrhythmias in children.
- To compare the effectiveness of TM with patient/parent symptom reporting.
Main Methods:
- A 3-year prospective study of 96 pediatric patients (ages 0.2-32.0 years) following pacemaker implantation.
- Utilized both routine monthly and on-demand emergency TM transmissions.
- Analyzed data on transmission compliance, detected abnormalities, and correlation with clinical findings.
Main Results:
- Routine TM showed 95% specificity and 99% negative predictive value for asymptomatic pacemaker dysfunction or dysrhythmias.
- Patient/parent symptom reporting had low sensitivity (29%) and positive predictive value (8%) for detecting pacemaker issues.
- TM was effective (p < 0.001) in correlating pacemaker status with subjective complaints across all ages.
- TM financial charges were significantly lower (p < 0.01) than outpatient visits.
Conclusions:
- Routine telephone monitoring is a highly specific and effective tool for pediatric pacemaker follow-up in the US.
- TM offers a cost-effective method for monitoring pediatric pacemaker patients, complementing subjective symptom reporting.
- The study supports the integration of TM into comprehensive pediatric pacemaker care protocols.
Abstract:
Although recommended as part of a comprehensive pacemaker follow-up protocol, the diagnostic and cost-effectiveness of routine telephone monitoring (TM) in children in the United States is largely unknown. Patient age and size with inherent age-related problems and potential inability to correlate symptoms with pacemaker performance places the pediatric patient in a unique category, different from that of the adult. A total of 96 patients, ages 0.2-32.0 years (mean 12.0 years) were followed for 3 years after pacemaker implant with both routine monthly and anytime emergency TM. A total of 1372 routine transmissions were performed of a recommended 3456 (40% patient compliance). Of these, 99% showed normal rhythm or pacemaker function. The remaining 1% demonstrated asymptomatic pacemaker dysfunction requiring intervention or new-onset dysrhythmias. A total of 75 emergency transmissions were undertaken for patient/parent-perceived problems, only 8% of which showed pacemaker dysfunction or dysrhythmias. The sensitivity of patient/parent capacity to detect pacemaker problems or dysrhythmias based on clinical findings was 29%, with a positive predictive value of 8%. The specificity of routine monthly TM to screen for asymptomatic pacemaker dysfunction or new-onset dysrhythmias was 95%, with a negative predictive value of 99%. TM was effective (p < 0.001) for correlating the presence or absence of pacemaker problems with subjective complaints at any patient age. Financial charges for use of TM were significantly less (p < 0.01) than comparable outpatient visits.