The research objective of this award is to develop guidelines for clinicians providing implanted cardiac device follow-up care for a variety of diverse classes of patients. Over 650,000 people in the United States currently rely on an implanted cardiac device for defibrillation and/or pacing, and this number is growing exponentially. Because these devices require such considerable follow-up care after implementation, many physicians are, or soon will be, unable to cope with this explosive volume. Remote monitoring technologies can serve to alleviate the follow-up burden for both patients and providers by reducing the need for time consuming office visits. However, clinicians are not permitted to control the devices remotely and do not obtain as much information from a remote follow-up as they would from an in-office visit. Moreover, remote monitoring can also contribute to the provider's burden by generating vast amounts of data that must be reviewed and possibly acted upon in a timely fashion, which can be very difficult in this workforce constrained environment. The research approach is to formulate and rigorously analyze novel mathematical decision models. Expected outcomes include decision rules for clinicians to use in determining the frequency with which to perform remote and in-office follow-ups for a panel of patients, which may include patients with devices under manufacturer-issued advisories and pacer-dependent patients with batteries near their end of life.
The results established through this research will significantly impact society by informing clinical practice, reducing health care expenditures and improving patient safety. Dissemination will include multiple journal publications and invited presentations to academic audiences at universities and international conferences. The educational impacts of this proposal will be experienced by graduate and undergraduate students as well as medical researchers through courses taught at various levels, mentoring and direct involvement in the research.
