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Home monitoring

Home monitoring, or remote monitoring, is used primarily to monitor patients with severe heart disease. As the majority of these patients have had implantable cardiac devices such as event recorders, pacemakers or ICDs fitted, these devices can be used to make home monitoring possible.

What is home monitoring?

Home monitoring - also known as remote monitoring or "CareLink" - refers to a process whereby patient data can be transmitted remotely, either between different physicians or between patients and physicians. Patients who have been fitted with a pacemaker can benefit from home monitoring in that the data collected by the device can be transmitted to the Heart Center on a regular basis using a standard telephone line.

Aside from requiring a standard telephone line, this process also requires a small device that is able to access the pacing device's information wirelessly from outside of the body, and then transmit it automatically. Data are encrypted prior to transfer to a secure server. One of the advantages of home monitoring is that pacemaker malfunctions can be detected early by the patient's physicians. Another advantage consists of the fact that patients whose pacemakers function as they should need less frequent follow-up visits, so that fewer appointments can be scheduled. Finally, remote monitoring does not require the patient to be at home but is also possible should the patient need to travel abroad or wish to go on holiday.

The development of home monitoring

In 1906, Willem Einthoven first described the remote transfer of biosignals in an article entitled "The Telecardiogram", which was published in the journal "Archives Internationales de Physiologie". The article describes how data from a single lead ECG were transferred from patients located at the University Hospital Leiden to a string galvanometer at the Physiology Institute using a telephone line over 1 mile in length. This development was followed in 1960 by NASA's work on the transfer of clinical data over great distances and, in the 1990s, by advances in the field of radiology, which made the remote transfer of x-ray images possible. The development of large broadband digital networks from 2000 onwards finally heralded the start of remote monitoring as part of routine clinical practice.

Who can benefit from home (remote) monitoring?

How can home (remote) monitoring help?

Home monitoring is not intended to reduce the level of direct medical care provided, let alone replace it altogether. Instead, it is intended to either complement certain aspects of this care or facilitate a more tailor-made approach.

Cardiac device-based home (remote) monitoring

Seriously ill patients who have either been fitted with a cardiac device such as a defibrillator (ICD), or are scheduled to have one fitted, can choose a device that is enabled for remote monitoring. When compared to remote monitoring that uses other systems currently available in the Berlin/Brandenburg area, cardiac device-based remote monitoring has one clear advantage: while other systems require additional devices and are monitored and controlled via control centers, remote monitoring-enabled cardiac devices offers simple functionality and fully automated processes, with all data directly transferred to, and analyzed by, the physicians responsible for the patient's care.

Selection of appropriate monitoring systems

A system will be chosen in consultation with the patient and after discussing the patient's specific medical needs, as well as assessing how well system requirements are likely to be supported by the technological setup in the patient's home. Once a system has been ordered, installed and tested, patient data such as heart rhythm, patient activity and intrathoracic impedance can be automatically recorded and, using a mobile network or fixed phone line, transmitted to the Heart Center where prompt analysis will take into account stored patient data.

Prompt action is possible should the need arise

Should these data reveal a sudden change that might indicate a change in the patient's therapeutic regimen, a prompt phone call can be placed to discuss this and/or make a recommendation. Our Center is currently engaged in a large-scale research study that may show this type of monitoring to have significant advantages for patients with heart failure when results are compared with standard monitoring via outpatient departments or local practices (OptiLink HF Study).

Close cooperation with local cardiology specialists

We value our good links with local cardiology specialists who are responsible for our patient's ongoing medical care. These specialists have the option of gaining direct access to the full set of patient data, or receiving written update reports. Many of the cardiology specialists working in private practices around the Berlin/Brandenburg have been cooperating with us since the early days of this venture.

Nurse Specialist for Home Monitoring

In order to ensure seamless monitoring and analysis of all remote monitoring data received, we have a certified Nurse Specialist with training in the management of home monitoring data (Nurse Specialist for Home Monitoring) who, in close cooperation with our cardiac specialists, monitors all data received and contacts patients promptly should the need arise.

Different base stations

Benefits of home monitoring

One of the proven benefits of this type of monitoring is that, when compared with standard monitoring via outpatient departments or private practices, home monitoring is better at monitoring device function, ensuring changes in function are recorded and detecting possible malfunctions early.
One advantage specific to a large area like Berlin/Brandenburg is that cardiac home monitoring can easily bridge the enormous distances that would normally involve attending follow-up appointments. As patients with heart failure are less able to cope with increased levels of strain and exertion, this marked reduction in long-distance travel results in an improved quality of life, as well as representing improved medical care as clinically relevant changes in the patient's status can be promptly acted upon.

Scope of home monitoring

We serve patients well beyond the borders of our region. The map provided shows the distances that can be bridged with home monitoring. Thanks to home monitoring, some of our patients have become sufficiently confident to be able to spend time abroad once more, including on extended stays. As a result, our home monitoring program extends as far as Scandinavia and the Middle East.

Over 100 of our patients are currently on our home monitoring program, many of whom reside within the Berlin/Brandenburg area.
The reach of the Brandenburg Heart Center's home monitoring program extends from Scandinavia to the Middle East.

Assessment with regard to patient's suitability for treatment with an implantable device Consultation with the patient regarding the pros and cons of home monitoring; assessment of patient's specific situation Implantation Follow-up through the outpatient

Case study - home monitoring

Analysis of home monitoring data revealed an apparent sudden increase in episodes of ventricular tachycardia. The patient was alerted and asked to attend an appointment at the Heart Center. A defective lead was identified as the cause of these changes, and was subsequently repaired.
After the defective lead has been replaced, the patient no longer experiences episodes of ventricular tachycardia. Early detection of a malfunction prevented unnecessary electric shocks from being delivered to the patient. Had the patient been monitored via traditional follow-up visits at six month-intervals, it would have taken much longer for this device malfunction to be identified.

Where can I find out more about home monitoring?

General information
Deutsche Gesellschaft für Kardiologie (German Cardiac Society):
dgk.org

General information
Deutsche Gesellschaft für Telemedizin (German Society of Telemedicine):
www.dgtelemed.de

General information
Deutsche Herzstiftung (German Heart Foundation):
www.herzstiftung.de

Research on home (remote) monitoring

Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink) Eur J Heart Fail. 2011 July; 13(7): 796–804

Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Eur J Heart Fail. 2010 Dec; 12(12):1354-62

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study. Eur J Heart Fail. 2011 Sep;13(9):1019-27

Martin Seifert, Viviane Moeller, Kay Brilla, J. Meyhoefer, Ch. Butter:
Analyse von technischen Anwendungsbeschränkungen und des Schulungsbedarfs der Patienten bei der CareLink Fernabfrage. [An assessment of the technical limitations and patient training requirements of a CareLink home monitoring program] Clin Res Cardiol 97: Suppl 2 (2008)

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