122Reducing the burden of unnecessary LINQ implantable loop recorder remote downloads by implementing an in-hospital multidisciplinary strategy to individualise management of patients with high volume downloads

Résumé fourni par la source

Introduction: LINQ TM implantable loop recorders (ILRs) were first implanted at Nottingham University Hospitals in January 2015. Unlike conventional ILRs which rely on in-clinic downloads (typically routine three-monthly follow up (FU) or when patient-activated), LINQ TMILRs are capable of continuous remote downloads either for routine 3-monthly FU, patient-activated events or pre-specified alerts. This has led to a significant increase in workload for our Pacing clinic (25 conventional ILR in-office downloads per month prior to introduction of LINQ TMILRS; 150 LINQ TM remote downloads per month after introduction of LINQ TMILRs). Methods: We aimed to (1) Establish the true burden of LINQ TM remote downloads in 3 months January- March 2016 (2016); (2) Establish the reasons for high volume of downloads (≥5 downloads per patient in 3 months); (3) Implement an in-hospital multi-disciplinary strategy aimed at reducing high volume downloads in appropriate patients by individualising their management; and (4) Re-audit one year after implementation of this strategy( 3 months March-May 2017 (2017)) to establish its effectiveness. Results: In 2016, a total of 83 patients implanted with LINQ TMILRs (11 % of all remote FU (RFU) patients) were responsible for 352 remote downloads (22 % of all remote downloads received by the Pacing clinic) in 3 months. In 2017, a total of 108 patients implanted with LINQ TMILRs (12% of all RFU patients) were responsible for 390 remote downloads (21% of all remote downloads) in 3 months. In 2016, 27 patients (33 % of total LINQ TM patients) had ≥5 downloads in 3 months (Figure 1) and were responsible for 264 downloads (75 % of all LINQ TM downloads). The maximum number of downloads per patient in 3 months was 32. Reasons for ≥5 downloads included: recurrent documented arrhythmias, under sensing, over sensing, patient symptoms but no arrhythmias seen. We implemented a multi-disciplinary strategy whereby any patient with ≥ 5 downloads in 3 months would have their case reviewed by the Pacing team (and Medical team where appropriate), and either device parameters re-programmed; patient reviewed, re-educated, listed for cardiac procedures; and/or medication prescribed. In 2017, 20 patients (18% of total LINQ patients) had ≥5 downloads (Figure 1) and were responsible for 202 downloads (52% of all LINQ downloads). The maximum number of downloads per patient in 3 months was 21. Conclusion: By implementing a multi-disciplinary strategy to individualise care of high volume remote download LINQ TM patients, we reduced the number of patients with ≥5 downloads in 3 months by 45%; and the number of downloads by these patients by 31 %. There is nonetheless potential for further impact of this strategy with further reinforcement and education within the multi-disciplinary team. Figure 1. Distribution of number of remote LINQ downloads in 2016 and 2017; high volume downloads ≥5 per patient in 3 months

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.