Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry.

AIMS: The HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management. METHODS AND RESULTS: The workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27% pacemakers, 27% single-chamber implantable cardioverter defibrillators (ICDs), 22% dual-chamber ICDs, 24% ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 ± 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51%): 2033 (82%) were detected during HM sessions; 438 (18%) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3% [confidence interval (CI), 82.5-86.0%] and 97.4% (CI, 96.5-98.2%), respectively. Overall, 95% of asymptomatic and 73% of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 1-14 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: +0.56 (CI, 0.53-0.58%), P < 0.0001. Resource consumption: 3364 HM sessions performed (76% by nurses), median committed monthly manpower of 55.5 (IQR, 22.0-107.0) min × health personnel/100 patients. CONCLUSION: Home Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.

Device diagnostics for heart failure: identifying eligible patients.

The prevalence of heart failure has increased by 500% over the past 30 years, creating a significant burden on the health care system. Traditional means of detecting worsening heart failure, such as subjective assessment, symptoms, and physical examination, lack sensitivity and specificity. Many nurses who manage heart failure patients have become interested in the role implantable cardiac devices play in monitoring patients' clinical status. In addition to providing therapies, some devices track and report diagnostic information that allows clinicians to more closely and effectively monitor patients, with the possibility of helping to prevent hospitalizations and improve patient outcomes. Optimal use of device diagnostics requires clinics to establish systems for recognizing patients who are eligible for device monitoring. This paper highlights various methods clinics have used to identify patients with implantable cardiac devices so that their device data can be used in conjunction with clinical evaluations to help guide patient care.

Maintenance of AV synchrony in a small child utilizing two pacemakers and the triggered VVT mode: triggered pacing in small children.

Infants and small children with atrioventricular (AV) nodal disease frequently require pacing in order to maintain an adequate heart rate. The maintenance of AV synchrony is physiologically optimal in this setting. Unfortunately, small size and congenital anomalies often preclude the placement of standard transvenous dual chamber pacing systems. We report the case of a small child with a pre-existing dual chamber epicardial pacing system and subsequent ventricular lead dysfunction who underwent implantation of a new single chamber transvenous system which was programmed in VVT (triggered) mode in order to maintain AV synchrony.

Bedside nurses removing epicardial pacer wires: from concept to practice.

Epicardial pacer wires inserted at the time of cardiac surgery are routinely removed prior to discharge. Traditionally, in most centres in Canada, this task has been carried out by physicians. Delays in discharge, insufficient patient preparation and inadequate monitoring practices post-wire removal have led to a need for a change in practice. The aim of this article is to present the development, implementation and evaluation of a project in which all bedside nurses on a post-operative cardiac surgery unit remove patients' epicardial pacer wires.

Cardiac resynchronisation therapy for patients with heart failure.

Cardiac resynchronisation therapy (CRT) is a non-pharmacological treatment for heart failure. The method 'resynchronises' the contraction of the right and left ventricles, resulting in better cardiac output, thus improving symptoms. This article discusses symptoms, morbidity and mortality of heart failure; potential benefits of CRT to patients' quality of life; and the implications of CRT for nursing practice.

[Practical nursing guide in the critical patient]. / Guía práctica de enfermería en el paciente crítico.

UNLABELLED: Nursing staff that have recently arrived to the ICU, nurses and students, may feel anxiety and fear due to lack of skill and/or knowledge of the techniques, the service's organization and the diseases treated. OBJECTIVES: 1. To know the intensive care aspects that pose greater difficulties to the professionals newly incorporated into the ICU of the Hospital General Universitario of Alicante 2. To provide these professionals with a written guide that responds to the needs and situations that they face day to day. 3. Inform the nursing students, prior to the onset of their practice activities in the ICU, on a combination of basic procedures that make it possible to take better advantage of them. 4. Communicate and facilitate access to the information contained in the guide to the maximum. MATERIAL AND METHODS: The professional workers who had recently received their degress and who worked in the ICU during the summery were surveyed to determine the techniques or procedures that posed the greatest difficulties. A <> was designed in paper and electronic form. RESULTS: The respiratory, Swan-Ganz catheter, defibrillation, cardiac arrhythmias and insertion of temporal pacemakers were the subjects posing the greatest difficulty. A total of 92% of the colleagues would re-chose their practices in the ICU; 33% liked working as a team most. CONCLUSIONS: 1. The technology used in the ICU poses problems for the recently arrived colleagues. 2. The guide may be used by the new professionals and students as work tool and contribute to communication between the university and the hospital. 3. The use of Internet to communicate the work done by the Nursing professionals offers great advantages and should be used as one more tool.

Cardiac resynchronization therapy: optimizing the device, optimizing the patient.

Heart failure is a major health problem in the United States, associated with high morbidity, mortality, and economic burden. Despite recent advances in pharmacological treatments to attenuate disease progression, medications become relatively ineffective, resulting in worsening congestive symptoms and increased exercise intolerance. Cardiac resynchronization therapy provides a new adjunct for heart failure patients who remain symptomatic despite optimized medical therapies. This article discusses cardiac resynchronization therapy and measures that should be considered to ensure proper functioning of the device and improved quality of life for patients.

Mastering temporary invasive cardiac pacing.

Competent management of patients with an invasive temporary pacemaker is an important skill for nurses who provide care for critically ill patients with cardiac disease. Such management requires familiarity with normal cardiovascular anatomy and physiology, conduction system defects, and rhythm interpretation. With an understanding of the basic concepts of rate, output, chambers, sensitivity, and capture, pacing can be done with ease. Care of patients with a temporary invasive pacemaker requires monitoring cardiac tissue and hemodynamic status, observing for changes that would indicate the need for modifications in the pacemaker settings. Nursing interventions include physical assessment, care of the insertion site, routine threshold testing, and management of the pulse generator.

Implications for nursing care of patients with atrial fibrillation: lessons learned from the AFFIRM and RACE studies.

Atrial fibrillation is the most common sustained cardiac dysrhythmia treated in North America and Europe. As such, it is one of the current epidemics in cardiovascular disease. Findings from the AFFIRM (Atrial Fibrillation Follow-up: Investigation of Rhythm Management) and RACE (RAte Control versus Electrical cardioversion for persistent atrial fibrillation) clinical trials are presented and the current evidence for the management of atrial fibrillation using anticoagulation, rate-control, and rhythm-control strategies is outlined. Implications for nurses are discussed including physiologic and psychosocial interventions.

Heart failure patients with ventricular dysynchrony: management with a cardiac resynchronization therapy device.

Despite an array of treatment modalities, the overall prognosis for patients with severe heart failure remains bleak. Biventricular pacing, or cardiac resynchronization therapy, is gaining increasing acceptance as a compelling treatment for those individuals with advanced heart failure (New York Heart Association functional class III or IV). This article provides a brief description of the atrial and ventricular conduction disturbances common in patients with advanced heart failure. Current indications for therapy are outlined, as are recent results of cardiac resynchronization therapy trials. The implant procedure is described to provide a comprehensive overview of this innovative approach to re-establishing normal electromechanical activity and synchronous right and left ventricular contractions. Patient care, before and after device implant, is also summarized. The focus on patient education throughout this article may allow it to serve as a reference for health care providers involved in the care of patients with severe heart failure.

An overview of permanent and temporary cardiac pacemakers.

As pacemaker technology comes closer to mimicking the heart's own pacing system, patients in need of such devices can hope to live increasingly normal and productive lives. This article outlines common types of cardiac pacing and indications for pacemaker insertion. Nursing considerations are outlined both during and following the insertion of a pacemaker.