Diagnostic and cost effectiveness of telemonitoring the pediatric pacemaker patient

J. A. Vincent, D. L. Cavitt, P. P. Karpawich

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Although recommended as part of a comprehensive pacemaker follow-up protocol, the diagnostic and cost-effectiveness of routine telephone monitoring (TM) in children in the United States is largely unknown. Patient age and size with inherent age-related problems and potential inability to correlate symptoms with pace-maker performance places the pediatric patient in a unique category, different from that of the adult. A total of 96 patients, ages 0.2-32.0 years (mean 12.0 years) were followed for 3 years after pacemaker implant with both routine monthly and anytime emergency TM. A total of 1372 routine transmissions were performed of a recommended 3456 (40% patient compliance). Of these, 99% showed normal rhythm or pacemaker function. The remaining 1% demonstrated asymptomatic pacemaker dysfunction requiring intervention or new-onset dysrhythmias. A total of 75 emergency transmissions were undertaken for patient/parent-perceived problems, only 8% of which showed pacemaker dysfunction or dysrhythmias. The sensitivity of patient/parent capacity to detect pacemaker problems or dysrhythmias based on clinical findings was 29%, with a positive predictive value of 8%. The specificity of routine monthly TM to screen for asymptomatic pacemaker dysfunction or new-onset dysrhythmias was 95%, with a negative predictive value of 99%. TM was effective (p < 0.001) for correlating the presence or absence of pacemaker problems with subjective complaints at any patient age. Financial charges for use of TM were significantly less (p < 0.01) than comparable outpatient visits.

Original languageEnglish
Pages (from-to)86-90
Number of pages5
JournalPediatric Cardiology
Volume18
Issue number2
DOIs
StatePublished - Mar 1997

Keywords

  • Children
  • Cost-effectiveness
  • Pacemaker
  • Telephone monitoring

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