Telemedizinische Applikationen in der Kardiologie

Telemedizinische Applikationen in der Kardiologie haben das Potenzial, die Diagnosefindung zu beschleunigen, durch frühzeitige Erkennung von zeitkritischen Befunden die Versorgung von Patient/-innen und damit letztendlich deren Lebensqualität zu verbessern und kardiovaskuläre Komplikationen zu verhindern. Nicht zuletzt während der COVID-19-Pandemie konnte gezeigt werden, dass die telemedizinische Versorgung in Krisenzeiten Versorgungslücken schließen kann.

Kernaussagen

• Telemedizin bedeutet, Informations- und Kommunikationstechnologien für die Prävention, Diagnose, Behandlung oder Weiterbetreuung von Patient/-innen zu nutzen.

• Die IN-TIME-Studie konnte zeigen, dass telemedizinische Nachsorge von Patient/-innen mit Herzinsuffizienz in einem strukturierten Disease-Management-Programm die Letalität reduzieren kann.

• Strukturierte Telemedizinprogramme mit Telemonitoring über implantierte Herzschrittmacher, CRT-Systeme, ICDs oder implantierte Pulmonalisdruckmesser können Re-Hospitalisierungen aufgrund von Herzinsuffizienz reduzieren.

• Zu den weiteren Anwendungsgebieten des Telemonitorings zählen Integritätskontrollen implantierter kardialer Devices sowie die Arrhythmiedetektion.

• Telemonitoring durch tragbare Rhythmusmonitore, die auf 1-Kanal-EKG- oder Photoplethysmografie-Messungen beruhen, hat aufgrund der breiten Verfügbarkeit das Potenzial, Arrhythmien frühzeitig zu erkennen.

Schlüsselwörter

Telemedizin - Telemonitoring - Herzinsuffizienz - Arrhythmien

Publication History

Article published online:
15 June 2021

• Literatur

• 1 Helms TM, Stockburger M, Kohler F. et al. [Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. Herzschrittmacherther Elektrophysiol 2019; 30: 287-297
• 2 Chaudhry SI, Mattera JA, Curtis JP. et al. Telemonitoring in patients with heart failure. N Engl J Med 2010; 363: 2301-2309
• 3 Koehler F, Winkler S, Schieber M. et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation 2011; 123: 1873-1880
• 4 Koehler F, Koehler K, Deckwart O. et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018; 392: 1047-1057
• 5 Angermann CE, Stork S, Gelbrich G. et al. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail 2012; 5: 25-35
• 6 Boyne JJ, Vrijhoef HJ, Crijns HJ. et al. Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial. Eur J Heart Fail 2012; 14: 791-801
• 7 Lynga P, Persson H, Hagg-Martinell A. et al. Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial. Eur J Heart Fail 2012; 14: 438-444
• 8 Hindricks G, Taborsky M, Glikson M. et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 2014; 384: 583-590
• 9 Abraham WT, Adamson PB, Bourge RC. et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658-666
• 10 Small RS, Wickemeyer W, Germany R. et al. Changes in intrathoracic impedance are associated with subsequent risk of hospitalizations for acute decompensated heart failure: clinical utility of implanted device monitoring without a patient alert. J Card Fail 2009; 15: 475-481
• 11 Boehmer JP, Hariharan R, Devecchi FG. et al. A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices: Results From the MultiSENSE Study. JACC Heart Fail 2017; 5: 216-225
• 12 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-2200
• 13 Brignole M, Auricchio A, Baron-Esquivias G. et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281-2329
• 14 Hindricks G, Camm J, Merkely B. et al. The EHRA White Book 2017 – The Current Status of Cardiac Electrophysiology in ESC Member Countries. 10th ed. Sophia Antipolis, Frankreich; 2017
• 15 Garcia-Fernandez FJ, Osca Asensi J, Romero R. et al. Safety and efficiency of a common and simplified protocol for pacemaker and defibrillator surveillance based on remote monitoring only: a long-term randomized trial (RM-ALONE). Eur Heart J 2019; 40: 1837-1846
• 16 Varma N, Epstein AE, Irimpen A. et al. Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation 2010; 122: 325-332
• 17 Lorenzoni G, Folino F, Soriani N. et al. Cost-effectiveness of early detection of atrial fibrillation via remote control of implanted devices. J Eval Clin Pract 2014; 20: 570-577
• 18 Shanmugam N, Boerdlein A, Proff J. et al. Detection of atrial high-rate events by continuous home monitoring: clinical significance in the heart failure-cardiac resynchronization therapy population. Europace 2012; 14: 230-237
• 19 Martin DT, Bersohn MM, Waldo AL. et al. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J 2015; 36: 1660-1668
• 20 Mairesse GH, Moran P, Van Gelder IC. et al. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). Europace 2017; 19: 1589-1623
• 21 Brignole M, Moya A, de Lange FJ. et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883-1948
• 22 Perez MV, Mahaffey KW, Hedlin H. et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med 2019; 381: 1909-1917
• 23 Pluymaekers N, Hermans ANL, van der Velden RMJ. et al. On-demand app-based rate and rhythm monitoring to manage atrial fibrillation through tele-consultations during COVID-19. Int J Cardiol Heart Vasc 2020; 28: 10053
• 24 Manninger M, Kosiuk J, Zweiker D. et al. Role of wearable rhythm recordings in clinical decision making – The wEHRAbles project. Clin Cardiol 2020; 43: 1032-1039