Diagnostic and cost effectiveness of telemonitoring the pediatric pacemaker patient

Pediatr Cardiol. 1997 Mar-Apr;18(2):86-90. doi: 10.1007/s002469900121.

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 pacemaker 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.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Electrocardiography
  • Humans
  • Infant
  • Monitoring, Physiologic / economics
  • Monitoring, Physiologic / methods*
  • Pacemaker, Artificial*
  • Telemedicine* / economics
  • Telephone*