Expert Interviews: Infrastructural Needs and Expected Benefits of Telemonitoring in VAD Therapy

Objectives: Outpatient management is key to improved therapy outcome, especially in ventricular assist device therapy and associated complications. Telemonitoring could play a key role, by reducing the number of postsurgical outpatient visits and early detection of complications. Telemedicine is already used for patients with chronic cardiac diseases and has been shown to reduce mortality. This study provides insight into LVAD-specific requirements for telemonitoring and infrastructural translation from a caregiver and patient point of view.

Methods: A qualitative investigation based on guided interview and focus group techniques was conducted at two German heart centers. It included 15 patients, 4 cardiac surgeons, and 3 VAD coordinators. Data was transliterated and assessed by qualitative content analysis according to Mayring. Categories for analysis were benefit for patients, hospital and health care system, acceptance and causative factors and practical infrastructural implementation.

Results: Patients and experts see the following benefits for telemonitored patients to varying extent: added safety, early detection of complications, fast interaction in case of emergency, regular inspection of pump parameters, fewer outpatient clinic visits as well as the ability to give more informed feedback and instruction to relatives. Expected acceptance of telemonitoring differed amongst interviewed groups. However, patients and clinical experts criticized reduced self-determination for the patient, effort for patient and caregiver and data protection/integrity issues (data misuse, device manipulation and mistransfer). Interviewees expect easy handling, proper education and safe data transmission as acceptance causative factors. Cost reduction, less hospitalization and complication rate reduction were healthcare system and clinic benefits. Clinical experts preferred a telemonitoring center run by VAD coordinators.

Conclusion: This widely accepted method gave detailed insight into both the patients' and clinical experts' requirements for a telemonitoring program. Thus, software and infrastructure developers will need to address e.g., variations in exercise of self-determination from patients and may need to balance designing individualized solutions for compliant patients and a safe and easy set-up. Additionally, a proper elucidation of users will contribute to a successful implementation of an LVAD telemonitoring program amongst patients and clinical experts.