Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Maria Liljeroos; Ingela Thylén; Anna Str?mberg

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机译：患者和护士的经验与对心力衰竭植入心脏除颤器的远程监测的看法：横截面，描述性，混合方法研究

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Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses ( P =.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses ( P =.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM ( P =.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.

机译：背景技术新一代植入式心脏除颤器（ICD）支持无线技术，可实现设备的远程患者监控（RPM）。在瑞典，它主要是注册护士，具有高等教育和培训的ICD设备，他处理了远程传输的心律失常和技术问题。以前的研究主要集中在医生的看法上，并且尚未探索患者和护士的RPM的经历彼此对应。目的是我们的目标是描述，探索，并比较关于ICD的RPM的经验和感知，心力衰竭（HF）和执行ICD随访的护士。方法本研究具有横截面，描述性混合方法设计。邀请从瑞典从基于办公室访问的一个地区的HF和ICD的患者与瑞典过渡到实施RPM的ICD护士，并被邀请瑞典的所有ICD诊所的ICD护士完成专门设计的8件问卷评估RPM的经验。调查问卷始于中立问题：“你的RPM一般经历是什么？”随后是一个正面船只，其中三个问题（得分范围3-12），重视更高的分数反映了更高的经验，以及一个负次级数据，其中三个问题（得分范围3-12），分数较低，反映了更负面的经验。通过定性内容分析分析了一个开放式问题。结果样品由175名患者（反应率为98.9％）和30名ICD护士组成（响应率60％）。大多数患者（154/175,88.0％）和护士（23/30,77％）经历了RPM，非常好;然而，护士注意到比患者更多的缺点。患者的负面经验的平均分数为11.5（SD 1.1），护士为10.7（SD 0.9）（P = .08）。患者的正面经验的平均分数为11.1（SD 1.6），护士为8.5（SD 1.9）（P = .04）。总共11名175名患者（6.3％）担心或焦虑地担心rpm所需的内容，而30名护士中有15名（50％）的责任伴随着与rpm一起工作的责任（p = .04）。患者发现转速增加了自己的（173/175，98.9％）及其亲属（169/175,96.6％）安全，所有护士（30/30，100％）回答，他们发现rpm是必要的安全视角。大多数患者发现它是较少的基于办公大学的优势。护士发现很难处理具有不同平台的不同系统，特别是对于少数患者的较小诊所。另一个困难是为各个患者设置正确的警报。这导致了大量的传输和错误错过重要信息的风险。结论患者和护士均发现RPM增加保证，依赖和安全。少数患者担心RPM所需的内容，而大约一半的护士受到与RPM一起工作的责任感到痛苦的感受。为了增加护士的安全感，调整组织例程和报销系统并平衡工作量似乎很重要。

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《Journal of medical Internet research》 |2020年第9期|共12页
作者
Maria Liljeroos; Ingela Thylén; Anna Str?mberg;
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heart failureremote patient monitoringimplantable cardioverter-defibrillator;

机译：Heart PredureeMote患者监测免疫程序 - 除颤器 - 除颤器;

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1. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: The evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study [J] . LandolinaM., PeregoG.B., LunatiM., Circulation: An Official Journal of the American Heart Association . 2012,第24期

机译：远程监测可减少植入式除颤器心力衰竭患者的医疗保健使用并提高护理质量：植入式除颤器心力衰竭患者管理策略的演变（EVOLVO）研究
2. Economic impact of remote monitoring after implantable defibrillators implantation in heart failure patients: an analysis from the EFFECT study [J] . AlessandroCapucci, AntonioDe Simone, MarioLuzi, Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology . 2017,第9期

机译：植入式除颤器植入心力衰竭患者植入后远程监测的经济影响：效果研究分析
3. Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively [J] . Maurizio Marzegalli, Maurizio Landolina, Maurizio Lunati, Trials . 2009,第1期

机译：设计具有植入性除颤器的心力衰竭患者管理策略的演变设计，以评估远程监控更有效地治疗和分类患者的能力
4. Clinical Experience of Implantable Cardioverter Defibrillator Capable of Biventricular Pacing in Heart Failure Patients [C] . W.S. Chan, K. Fan, K. Lee, World Congress on Cardiac Pacing and Electrophysiology . 2003

机译：植入心肺除颤器的临床经验能够在心力衰竭患者中生前衣
5. Impact of Nurse-Practitioner Led Structured Telephone Communication for Heart-Failure Patients with Implanted Telemonitoring Technology [D] . Gregoire, Sharon A. 2019

机译：护士从业者LED结构化电话通信对植入诊所诊断技术的影响
6. Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively [O] . Maurizio Marzegalli, Maurizio Landolina, Maurizio Lunati, 2009

机译：设计具有植入式除颤器的心力衰竭患者管理策略的演变设计以评估远程监控更有效地治疗和分诊患者的能力
7. Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively [O] . 2009

机译：设计具有植入式除颤器的心力衰竭患者管理策略的演变设计，以评估远程监控更有效地治疗和分诊患者的能力

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