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.
