| Background and ObjectiveCardiovascular disease(CVD)is a common disease that seriously endangers human health and has always been the foremost cause of death in the world.As its morbidity and mortality have been increasing year by year,cardiovascular disease has drawn more and more attention,which not only brought patients mental and physical pain,but also brought heavy financial burden to families.The global death toll from cardiovascular disease reached 17 million in 2010,causing direct and indirect economic losses of about 863 billion U.S.dollars.It is estimated to increase to 1,044billionU.S.dollars in 2030.At the same time,our country is also in the period of high burden of chronic diseases.The number of deaths caused by chronic diseases in our residents is 85%of the total deaths,and the economic burden is 70%.With the development of medical science and technology,advanced treatment methods such as coronary artery bypass grafting(CABG),percutaneous coronary intervention(PCI),radiofrequency ablation(RF)of atrial fibrillation(AF)andcardiac resynchronization therapy(CRT)have been widely carried out at home and abroad,which has greatly improved the quality of life of the cardiovascular disease patients.These treatments can quickly and effectively alleviate the symptoms,but they can not stop the process of coronary atherosclerosis,can not reverse the pathological process of coronary atherosclerosis,and can not relieve the risk of cardiovascular events such as psychological factors,bad habits,can not take medicine on time,blood pressure and blood glucose control is not standard,weight control is not ideal,which will lead to the recurrence of disease,such patients should be systematic,standardized follow-up and behavior intervention to improve patient compliance,improve prognosis.At present,although there are a large number of medical institutions in our country,the medical standards of various institutions are uneven and the top three hospitals are overcrowded.On the one hand,the limited medical resources make the problem of medical treatment still difficult.In fact,the vast majority of patients with chronic diseases do not need to go to hospital frequently.They only need to regularly monitor health indicators and be guided by doctors.Extensive outpatient visits for chronic diseases have caused a waste of hospital resources and excessive expenditures on social health insurance.On the other hand,each time a patient visits a hospital for outpatient visits,he spends a lot of time queuing,registering,paying,checking,and referring.For patients in remote areas,considering the long way back and forth,then adds the extra financial burden,consumes more energy.At present,outpatients generally use paper cases to record the patient’s treatment information,patient’s related medical history,physical examination,:,auxiliary examination and past medication without electronic backup.Once the medical record or the checklist is lost,it will lead to valuable historical data lack,not only increase the financial burden on patients,more importantly,it will affect the doctor’s judgment of the patient’s condition and treatment plan.Internet medical treatment is a new type of medical treatment that accompanied with the rapid development of the Internet.It has the characteristics of promptness,accessibility,pertinence,economy and rationality.Making medicine transcend national and regional boundaries is a major feature of Internet medical,and the new cyberpattern breaks through the limitation of timeliness and enables unprecedented real-time and interaction with ever-increasing value and influence.Modern information science and technology provide the conditions for the realization of Internet medical and health management.By means of modern network and communication technologies,the effect of face-to-face two-way communication and two-way interaction can be achieved through network communication technologies such as satellite,internet and telephone lines.Through the computer’s collection,storage,analysis and application of the network for health informationand dynamic management of health,can improve the accuracy of health management and the efficiency of the doctor’s work,is the basic platform for achieving large-scale health management.Therefore,the combination of follow-up management of patients with cardiovascular diseases and Internet medicalservices to build a follow-up modethat can provide real-time,trans-regional,long-term and easy operation,which can solve the current shortage of medical resources,improve patient drug compliance and reduce patients economic burden,thus avoid the waste of medical resources.With the development of medical science,many acute death rates of cardiovascular diseases have dropped dramatically,gradually developing to the stage of chronic disease.The management of chronic disease stages in these patients is closely related to their prognosis.This is a major problem facing China’s health care and even the global medical and health work.China’s current medical resources and the current chronic disease management modeare still unable to meet the needs of the growing number of patients with chronic diseases.With the aging of the population of our country and the world,this contradiction becomes increasingly prominent.After the acute phase,patients with chronic diseases should be treated according to the medical rehabilitation plan developed by the doctors.The doctors need to follow-up each person with chronic diseases so that they can communicate with the follow-up doctors on a regular basis or when the condition changes,contact them for review of necessary items,and adjust the treatment plan to reduce the chances of re-hospitalization.At present,the management mode of chronic patients in our country is still the patients to the hospital for medical treatment.Due to the current lack of medical resources in our country and the imbalance of geographical distribution,many patients can not get regular referral.Many patients stop taking medications on their own or even return to unhealthy life after taking the doctors’ prescriptions.As a result,many patients relapse soon,increasing patients pain and financial burden.How to better manage these patients with chronic diseases,reduce the number of hospitalizations,reduce their medical costs and improve their quality of life are currently major issues facing cardiologists in China and around the world.Based on this concept,we have introduced Internet technology into the management of patients with chronic cardiovascular disease and tried to develop an efficient,portable,information-based chronic disease management system for cardiovascular patients by means of the ever-evolving information technology of the health and medical equipment,apply it to chronic disease management of patients with cardiovascular disease,subvert the existing management of chronic disease in our country,and explore a suitable management mode for patients with chronic disease of cardiovascular disease in our country.Methods1.Portable mobile medical devices developmentand clinical validation1.1 Portable mobile medical devicesdevelopmentWe collaborated with the Computing Center of the Shandong Academy of Sciences to investigate relevant information of patients with cardiovascular diseases,study relevant literature on health management,consult relevant experts in the field,and complete the analysis report on the needs of the cardiovascular disease health management system.Combining modern computer information technology,including key technologies of diversified weak medical signal precision sensing,general and extensible medical data intelligent processing,smart medical terminal lightweight design,developed a portable mobile medical device that integrates blood pressure,oxygen saturation,body temperature,ECG,pulse,blood glucose,uric acid,blood lipids,hemoglobin,and urine routines,and a chronic disease follow-up system based on cardiovascular diseases on the Internet platform(abbreviated as Follow-up System).Portable mobile medical equipment relying on advanced cloud health management,measurement data upload at any time on the Internet.Doctors can understand the patient’s condition changes in real time through terminals such as mobile phones and computers,and provide feedback in a timely manner,enabling dynamic monitoring of patient health status through the Internet platform.Individuals can personally assess their personal health assessment results and health guidance programs online through real-time online self-assessment,health status entry,and online health consultation via the Internet platformof chronic disease follow-up system for cardiovascular disease.The patient timely feeds back the individual’s health changes after the implementation of the plan so that the doctor can develop a more complete and personalized plan.1.2Clinical validation of portable mobile medical devicesRandomly selected 100 inpatients from Qilu Hospital of Shandong University to take venous blood samples and detect hemoglobin,blood glucose,uric acid,and blood lipids with portable mobile medical devices.Simultaneously with the SYSMEX XE-2100 automatic blood analysis of the Qilu Hospital of Shandong University Roche cobas 8000 automatic biochemical analyzer detects the above items and verifies the accuracy of the devices.2.Follow-up SystemapplicationDuring the period from January 2016 to December 2017,there were 68 patients who were admitted to the Department of Cardiology at Qilu Hospital of Shandong University or inpatients and met the inclusion and exclusion criteria,the details of the research related to the study were explained and explained to all the enrolled patients the objectives and methods,all patients expressed understanding and signing of informed consentandquestionnaires(Drug Compliance Questionnaire,Living Habit Questionnaire)at the time of enrollment;the portable mobile medical device was provided to the enrolled patients.Special persons are required to train the patients in the use of the device and ensure that each patient or their children can perform skillfully;Perfecting the follow-up of each patient’s electronic medical records(current medical history,past history,personal history,family history,and physical examination,etc.)and current medication plans.The patient uses portable mobile medical device to detect blood pressure,oxygen saturation,body temperature,ECG,pulse,blood glucose,uric acid,blood lipids,hemoglobin,and urinalysis at the home and uses a follow-up platform to communicate with the doctor in real time to achieve self-interview,assessments,health status entry,online health consultations,etc.through the Internet.The doctor obtains the patient’s health assessment results online,conducts the next step guidance program,and timely obtains the patient’s health changes following the implementation of the protocol.After 6 months of follow-up,all patients completed the questionnaire again at the end of the 6th month(Drug Compliance Questionnaire,Living Habit Questionnaire,Economic Time Questionnaire and Cardiovascular Disease Follow-up Pattern Satisfaction Comparison Questionnaire).3.StatisticsData was analyzed using SPSS 18.0 statistical software.Measurement data(mean±standard deviation)said,comparion within groups used paired t test,while the comparison between groups using two sample t test.For disregard of normal distribution measurement data or rating data,apply the rank sum test.All P values are double-sided.P<0.05 for the difference was statistically significant.Result1.Verification of portable mobile medical device detection:Venous blood specimens,portable mobile medical device detection indicators:blood glucose,uric acid,blood lipids,hemoglobin and Clinical Laboratory tests of Qilu Hospital,Shandong Universityhad no statistically significant differences(P>0.05).2.Before and after entering the group,patients with drug compliance increased,there were statistical differences before and after enrollment(P<0.01);lifestyle improved,there were statistical differences before and after enrollment(P<0.01).3.Comparing the effectiveness of the patient’s Internet platform follow-up mode with that of the traditional outpatient follow-up mode,the follow-up time of the Internet platform follow-up mode was significantly less than that of the traditional outpatient follow-up mode,and the time benefit was statistically significant(P<0.01).4.Comparing the economic benefits of patients Internet follow-up mode and traditional out-patient follow-up mode,the cost of internet platform follow-up mode was significantly lower than that of traditional out-patient follow-up mode,the economic benefit was statistically significant(P<0.01).5.Internet platform follow-up mode and Traditional out-patient follow-up mode Satisfaction of visits:There was a statistically significant difference in overall satisfaction,health information satisfaction,doctor-patient communication satisfaction,and adjustment of drug timeliness satisfaction(P<0.01).The Internet platform follow-up mode was superior to the traditional out-patient follow-up mode;There was no statistical difference in efficacy satisfaction and test satisfaction(P>0.05).The Internet platform follow-up mode was comparable to the traditional outpatient follow-up mode.Conclusions1.Portable mobile medical devices detection indicators and Clinical Laboratory tests of Qilu Hospital,Shandong University have no difference.The indicators of portable mobile medical devices are accurate and reliable.2.The Internet-based Platform for Chronic Disease Follow-up System for Cardiovascular Diseases can improve Patient’s drug compliance,improve living habits,reduce follow-up costs,and reduce follow-up time,with good economic and time benefits,providing clinicians with a new modefor managing patients with chronic cardiovascular disease.3.The application of the Internet + platform follow-up mode is equivalent to the Traditionaloutpatient follow-up modein terms of the treatment effect and examination and testing of patients.The patient’s overall follow-up effect,access to health information,communication with doctors regarding disease information and feelings,and timeliness of drug adjustment were superior to Traditional outpatient follow-up mode.4.The Internet + platform follow-up mode is more suitable for the management of patients with chronic diseases of cardiovascular disease than the traditional outpatient follow-up mode.It is worth spreading widely.Background and ObjectiveAtrial fibrillation(AF),the most common tachyarrhythmia,is an important factor in the high morbidity and mortality of cardiovascular disease.It has become one of the serious challenges in the global cardiovascular disease field in the 21st century.Atrial fibrillation epidemiology shows that about 5 million people in the United States suffer from atrial fibrillation.The American Heart Association Atrial Fibrillation Writing Group estimates that the number of AF patients will double in the next 25 years.The prevalence of atrial fibrillation in Europe is similar to the United States.In China,the number of patients suffering from atrial fibrillation has exceeded 10 million.With the advent of an aging society,the number of patients suffering from atrial fibrillation will continue to increase.According to the research report,the risk of stroke in patients with atrial fibrillation is increased by 5 times,the risk of heart failure is increased by 3 times,and the total mortality is increased by 2 times.Thromboembolic complications are the main cause of death and disability in atrial fibrillation.Stroke is the most common type of manifestation and it is the greatest threat to patients with atrial fibrillation.Catheter ablation of atrial fibrillation has evolved from an unimaginable concept in the early 1990s to a major means of treating paroxysmal atrial fibrillation(PAF)and drug-refractory atrial fibrillation in the late 1990s.A number of studies have shown that radiofrequency catheter ablation(RFCA)treatment of atrial fibrillation has obvious advantages over drug therapy.With the gradual maturity of ablation techniques,patients with AF after radiofrequency catheterablation have gradually increased.According to the requirements of the National Health and Hygiene Committee,patients undergoing catheter ablation after atrial fibrillation require a 100%follow-up rate,and most of the current follow-up forms are regular visits to hospitals or telephone follow-ups.Some patients often fail to follow postoperative follow-up for various reasons.On the one hand,some patients with atrial fibrillation do not have obvious symptoms at the onset,that is,occult atria]fibrillation.These patients subjectively believe that there is no discomfort,they do not need follow-up to the hospital;on the other hand,radiofrequency catheter ablation is performed in the top-three hospitals in major cities or experiencedAtrial FibrillationCenter.Some patients lived in remote areas,considering the round trip and the current status of the top-three hospitals,the off-site follow-up treatment not only takes a lot of time,but also increases the economic burden.Therefore,patients after radiofrequency catheterablation lack effective management approaches.This article applies the Internet platform for the chronic disease follow-up system of cardiovascular disease to follow-up and managepartial patientswith radiofrequency ablation during the period from January 2016 to December 2017 in our AF center:Patients apply the portable mobile medical equipment developed by our team at home.Regular or untimely check ECG,blood pressure,blood glucose,uric acid,blood lipids,hemoglobin,urine,and other indicators,measurement data can upload at any time on the network,doctors can use mobile phones,computers and other terminals in real time to understand the patient’s condition changes and timely feedback.The follow-up period of the application platform was six months.By statistically analyzing random ECG,echocardiography(LAAPD),presence or absence of palpitations,age,gender,comorbidity,blood pressure,blood glucose,blood lipids,and uric acid to evaluate the recurrence rate of radiofrequency ablation after atrial fibrillation in our center,observe the postoperative stable period,analyze the risk factors affecting the recurrence after radiofrequency ablation of atrial fibrillation,and explore the operability of this follow-up system by applying the Internet platform for cardiovascular disease chronic disease follow-up system to manage patients after radiofrequency ablation of atrial fibrillation.Research Method1.General InformationFrom January 2016 to December 2017,42 patients were hospitalized in the Department of Cardiology of Qilu Hospital of Shandong University and met the inclusion and exclusion criteria,who were treated with radiofrequency ablation;all patients were enrolled and explained the study details,purposes and methods,etc;All patients expressed understanding and signed informed consent;every patients to be issued a portable mobile medical equipment,by a dedicated person(cardiology professional doctors and software developers)on the use of equipment for patients Training,and ensure that each patient can be proficient in operation;perfect the electronic medical records for each follow-up patient(current history,past history,personal history,family history,physical examination,etc.),upload the patient during laboratory tests(echocardiography,blood glucose,lipids,uric acid,coagulation series and other laboratory tests)and the current medication program.The patient used a portable mobile medical device to test blood pressure,blood oxygenation,body temperature,ECG,pulse,blood glucose,uric acid,blood lipids,hemoglobin,and urine routines at home.Patients use the internet platform to communicate with doctors in real time,and the doctor combined with the health assessment results obtained online to take oral anticoagulant drugs(OAT),anti-arrhythmia drugs(AAD)adjustments and health guidance.The patient’s timely feedback the health changes after the implementation of the protocol.The above-mentioned platform was used for a 6-month follow-up study of patients undergoing radiofrequency ablation of atrial fibrillation.2.Postoperative treatment2.1 Postoperative medicationPatients undergoing radiofrequency ablation of atrial fibrillation undergo oral anticoagulant therapy,anticoagulation with warfarin or a new oral anticoagulant(dabigatran or rivaroxaban),antiarrhythmic drugs amiodarone,or propafenone for 3 Months,if there is no recurrence of atrial fibrillation,stop it.2.2 PostoperativeFollow-upAfter the patients were enrolled in the group,routine examinations such as ECG,blood pressure,hemoglobin,uric acid,blood glucose,blood lipids,and urine routines were performed at 1 month,3 months,and 6 months after the operation.According to the patient’s condition,they were examined at the local hospital or Qilu Hospital of Shandong University for echocardiography and dynamic electrocardiogram.After the patient ’s condition changed or the above examination was performed,the patient passed a real-time message to the follow-up doctor to briefly describe the situation.Physicians monitor their ECG,episodes of symptoms,presence of hemorrhage(hemoglobin and urine routine reflect indirectly)and communicate in real time through the Internet platform for cardiovascular disease follow-up system.Doctors refer to patients’ ECG,blood pressure,blood glucose,and blood lipids for examination and symptom,Guide medication or advice;The patient timely feedback changes in electrocardiogram,blood pressure,blood glucose,blood lipids,and subjective symptoms after changing the treatment plan;If any acute conditions occur during the follow-up period,visit the local hospital promptly.3.Data ProcessingSPSS 18.0 statistical software was used to analyze the data.Measurement data are expressed as(mean ± standard deviation)and t-tests are used;count data are expressed as a percentage and χ2 test is used.All P values use a two-sided test.P<0.05 was considered statistically significant.Results1.During the study,there were 42 patients undergoing radiofrequency ablation at the Atrial Fibrillation Center of Qilu Hospital,Shandong University,and 6 patients had recurrence.The overall recurrence rate was 14.29%.There were 18 cases of persistent atrial fibrillation,4 cases of recurrence,recurrence rate of 22.22%,24 cases of paroxysmal atrial fibrillation,2 cases of recurrence,recurrence rate of 8.33%.The recurrence rate after radiofrequency ablation of atrial fibrillation performed at the Atrial Fibrillation Center of Qilu Hospital of Shandong University was lower than that reported in the previous literature(33.0%to 60.7%).2.Electrocardiogram monitoring of patients revealed that atrial arrhythmia occurred within 8 weeks after radiofrequency ablation,including atrial fibrillation,atrial flutter and atrial tachycardia,and atrial arrhythmias were significantly reduced during 8-16 weeks.It stabilized after 16 weeks.With the prolongation of the time after ablation,the frequency of atrial fibrillation gradually decreases,and gradually stabilizes,and this monitoring method can greatly improve the detection rate of occult atrial fibrillation.3.Symptoms of patient’s postoperative self-consciousness were obvious within 1 month.The patient’s subjective symptoms peaked in the 2nd week,sharply decreased in the 4th week,and stabilized after 1 month.Conclusion1.The internet platform for cardiovascular disease chronic disease follow-up system can promptly guide postoperative drug treatment and condition monitoring of patients after radiofrequency ablation of atrial fibrillation with a new follow-up mode,and adjust the treatment plan in time,which helps to reduce recurrence rate after radiofrequency ablation of AF.2.Reduced the patient’s discomfort at the stage of symptom-sensitivity at the first postoperative stage,improved the patient’s quality of life;improved the detection rate of occult atrial fibrillation,helped doctors better evaluate the effect of surgery and patient prognosis,better management Patients with atrial fibrillation.3.The Internet follow-up system provides clinicians with a new modefor patient management after radiofrequency ablation of atrial fibrillation. |
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