Case study: Pacemaker telemonitoring for heart failure
What did we do?
The Welsh Cardiac Network requested an appraisal on pacemaker telemonitoring (remote monitoring) for the management of heart failure.
Our exploratory literature searches highlighted a lack of evidence in this area, but it was apparent that there were highly-relevant organisational issues, particularly relating to how telemonitoring outputs should be used clinically. To address these issues, we hosted a workshop to optimise pacemaker telemonitoring throughout Wales, where stakeholders could share and learn from examples of good practice.
Over 40 people attended the workshop. Stakeholders included:
- Senior NHS staff
- Other healthcare professionals
- Patient groups
- Experts with an interest in appraisal of evidence to inform decision-making in NHS Wales.
“I hope that HTW will organise more events like this.”
What did we learn?
Clinical teams described three main approaches currently used in practice:
- No telemonitoring of pacemakers.
- Telemonitoring to check that the pacemakers were functioning correctly (e.g. battery life).
- Telemonitoring with review of data to inform clinical decision-making (in addition to functional checks).
Stakeholders valued having a dedicated opportunity to come together and share their experiences. All feedback forms indicated that participants were satisfied or very satisfied with the overall experience, and with the organisation of the event.
What difference did this make?
Attendees agreed that an all-Wales, multi-stakeholder approach was needed to use pacemakers optimally in the management of care for people with heart failure.
Some of the main conclusions from the workshop included:
- Central support could be provided to address the technical and compatibility issues that arise with telemonitoring infrastructures.
- Evidence about the accuracy of the telemanagement algorithms needs to be shared by manufacturers.
- Stakeholders need to consider and agree the details of practical implementation.
The provision of more consistent care throughout Wales is expected to reduce geographical inequity. Effective use of telemonitoring may be particularly valuable in rural areas where distances between healthcare providers vary.