Telemonitoring in der Devicetherapie: gelebte Wirklichkeit?

Zusammenfassung

Nahezu alle auf dem Markt befindlichen implantierbaren Rhythmusdevices eröffnen heute die Möglichkeit des Telemonitorings. Diese Option bietet die Chance, die Betreuung dieser Patienten sowohl unter ökonomischen als auch unter medizinischen und sicherheitstechnischen Aspekten zu optimieren. Die telemedizinische Überwachung von Patienten mit ICD- oder CRT-System fügt sich sinnvoll in das Konzept eines optimierten Herzinsuffizienzmanagements ein. Kardiologische Fachgesellschaften haben das telemedizinische Devicemonitoring in den aktuellen Guidelines bereits positiv bewertet. Die breite Nutzung dieser Option scheitert trotz ausreichender Datenlage, aktuell vor allem am Fehlen einer adäquaten Vergütung telemedizinischer Verfahren im ambulanten und stationären Bereich. Dem Patienten wird u. U. durch den nicht genutzten Einsatz eines technisch möglichen telemedizinischen Devicemonitorings ein höheres Maß an Sicherheit und die frühzeitige Optimierung therapeutischer Ansätze vorenthalten. Im kürzlich verabschiedeten E-Health-Gesetz ist die Telekardiologie unverständlicherweise nicht vorgesehen. Es bleibt zu hoffen, dass im Rahmen künftiger Gesetzesvorhaben die Einführung dieser modernen Optionen in die Regelversorgung ermöglicht wird.

Abstract

Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. Using TM has the potential to optimize patient care with regard to clinical, safety, and economic aspects. Thus, TM of patients with ICD or CRT devices can reasonably be included in a concept of optimized heart failure management. Meanwhile, a number of guidelines or scientific statements provide evidence-based positive recommendations with respect to the use of TM in CIEDs. Despite this fact, a broader application of TM is hampered primarily due to inadequate reimbursement of the technique, both in an outpatient and in-hospital setting. Thus, a considerable number of patients are currently deprived of the advantages of TM such as higher therapeutic safety and promptness of treatment optimization. In contrast to the federal government policy statement to promote the dissemination of TM, telecardiology has not been included into the recently adopted e-Health Act. It remains to be seen whether a future legal bill will facilitate introduction of this promising therapeutic options into standard medical care.

Schlüsselwörter

Telemedizin - Remote-Monitoring - Remote-Follow-up - Devices - Arrhythmien

Key words

telemedicine - remote monitoring - remote follow up - devices - arrhythmias

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