JMIR Publications

ABSTRACT

Background:

The new generation of implantable cardioverter defibrillators (ICD) supports wireless technology which enables remote monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with specific knowledge in ICD care that handles 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 RMP corresponds to each other.

Objective:

To describe and explore experiences and perceptions concerning RPM of ICD in patients with heart failure (HF) and cardiac nurses.

Methods:

The study had a cross-sectional, descriptive mixed method design. All patients with HF and an ICD with RPM from one region in Sweden, that had transitioned from office-based visits to implementing RPM, and ICD nurses working at all the ICD clinics in Sweden were invited to completed a purpose-designed 8-item questionnaire to assess their experiences of RPM. The questionnaire had one positive subscale (range 3 to 12) with higher scores reflecting more positive experiences, and one negative subscale (range 3 to 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%) and 30 ICD nurses (response rate 60%). The majority of patients (88.0%) and nurses (76.6%) experienced RPM as very good, however the nurses noted more downsides than the patients. The mean score of the negative and positive experiences’ subscales were 11.5±1.1 for the patients and 10.7±0.9 for the nurses (P<.09), and 11.1±1.6 for the patients and 8.5±1.9 for the nurses (P<.05), respectively. Patients found that RPM increased their own (98.9%) and their relatives (96.4%) security, and all nurses answered that RPM found RPM necessary from a patient safety perspective. 50% of the nurses found the responsibility that accompanied working with RPM increase their security since they knew there would be an alert in case of malfunction or arrhythmias. A majority of the patients found it to be an advantage with fewer office-based visits. About half of the nurses found the responsibility that accompanied their work with RPM worrying. To handle different systems with different platforms were highlighted as a difficulty, especially for smaller clinics with few ICD patients. Another difficulty was to set the right amount 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 haft of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ security it seems important to adjust organizational routines and reimbursement systems and balance the workload.