A systematic and evidence-based approach to assessment of NHS organisational readiness to commence haemodynamic remote monitoring through cardiovascular implantable electronic devices (CIEDs) in routine heart failure care. (SEARCH-HF)

Abstract

Background & Aims It is hypothesised that successful remote monitoring (RM) of patients with heart failure (HF) using cardiovascular implantable electronic devices (CIEDs) is related to the context within which the technology is used and integrated into decision-making. There is currently little guidance on how a UK clinic should perform high quality RM. The aim of this project was to provide an evidence-based approach to RM of HF patients by 1) identifying necessary pre-requisite competence to facilitate successful introduction of RM; 2) mapping a care pathway in an NHS setting for CIED-based RM of patients with HF; and 3) developing an assessment matrix of key requirements for optimal CIED-based RM. Methods A mixed-methods study was undertaken incorporating both quantitative and qualitative data from the process of CIED-based RM. Quantitative data were gained from a systematic review of literature on facilitators of, and barriers to, high quality RM. A process mapping workshop was undertaken at the Royal Brompton Hospital to identify the intricacies of the clinical pathway at an experienced RM centre. These data were supplemented by semi-structured interviews with patients and healthcare professionals to develop important themes on RM of HF patients to give a coherent interpretation of the RM process studied. Results After identifying 64 relevant publications and undertaking a process-mapping exercise on initiation of RM and responding to an alert, interviews with 12 patients and seven healthcare professionals were undertaken. The key themes emerging from these data were incorporated into a model RM pathway and pathway-anchored assessment framework. Conclusions This is the first study to investigate barriers to, and facilitators of, high quality CIED-based RM in a UK HF clinic. The tools generated from this study will allow other NHS centres to assess the key organisational, educational and data processing requirements to ensure high quality RM.Open Acces