Telemedicine Is Applied To The Management And Preliminary Research Of Patients After Cardiac Resynchronization Therapy

Background: Cardiac resynchronization therapy(CRT)has been recognized as one of the effective treatments for patients with chronic heart failure(HF)accompanied by cardiac dyssynchrony,but nearly one-third of patients still show no response or low response.The perioperative management and postoperative follow-up of CRT are one of the important factors affecting the response rate.In clinical patients with chronic heart failure who received CRT for the first time and those who received pacemaker implantation and later upgraded to CRT,there may be differences in the cognition degree of heart failure disease and the matters needing attention of pacemaker,so it is necessary to conduct targeted follow-up management between them.Objective: The purpose of this study was to evaluate the feasibility of the model of telemedicine treatment in postoperative patients with CRT,and explore the upgrade CRT and De novo CRT these two kinds of people to disease and cognitive degree of difference.And to explore under the telemedicine mode,the value of different people strengthen follow-up management and evaluation to upgrade the CRT operation is as effective as De novo CRT.Methods: Patients who received CRT in north jiangsu people’s hospital from September 2017 to June 2019 were enrolled for at least 6 months of remote follow-up management.After enrollment,according to patients’ awareness of disease and perioperative nursing of pacemaker,targeted health education was carried out and individualized management plan was developed.During the follow-up,a corresponding personal disease file was established for all the patients.The family was taken as the unit,and the mobile APP was used as the information medium to carry out the doctor-patient information interaction.Regular follow-up visits were arranged for the patients 1 week,1 month,3 months and 6 months after CRT.During the follow-up,the pacemaker was programmed by the cardiologist and the drug and pacing parameters were adjusted individually.Assess the feasibility of the telemedicine management model,including satisfaction,engagement,and changes in patients’ psychological status.At the end of the follow-up for 6 months,the cognition degree of patients in the two groups was evaluated again.Meanwhile,the improvement degree of patients’ cardiac function was evaluated by NYHA,6min walking distance(6MWD)in the two groups at 1 week,1 month,3 months and 6 months after CRT.Results: In this study,a total of 53 patients underwent telemedicine management after CRT.During the whole study period,a total of 187 accurate medical follow-up were completed,187 follow-up data were formed on the mobile phone APP,a total of 187 pacemakers were programmed,and 89 pacemaker parameters were optimized(89/187,87.6%).All patients underwent at least 2 postoperative follow-up.Most of the patients’ families were satisfied with this follow-up model.After 6 months of follow-up,a total of 45 groups(84.9%)completed the psychological part of the effective SF-12 scale,and their psychological status was improved(44.0±12.2 vs 66.5±14.9,P < 0.001).In the subgroup study,there were 17 patients with upgraded CRT,and 36 patients were De novo CRT.The score of disease cognition in De novo CRT were more than 2,Q1 、 Q2(1.53±0.56vs2.19±0.61,1.53±0.59vs2.25±0.72),that of the upgraded CRT group was more than 2,Q3、Q4(2.06±0.63vs1.89±0.52,2.82±0.56vs1.75±0.45).The intention of communication disease in both groups was greater than 2 points,Q6(2.18±0.63vs2.25±0.62).In the CRT upgrade group,scores of Q1,Q2,Q3 and Q5 increased after follow-up,P < 0.05;in the CRT group,scores of Q1,Q3,Q4 and Q5 increased after follow-up,P < 0.05;the remaining questions’ score of the two groups increased mildly after follow-up,P >0.05.6MWD、NYHA of all patients with CRT and two subgroups were improved 6 months after CRT(P < 0.05).Conclusion: 1.Telemedicine management is feasible for patients after CRT,and most of them are satisfied and can participate in the follow-up plan.After 6 months of follow-up,it is proved that this follow-up model is beneficial to the improvement of patients’ mental health.2.Both subgroups of patients with CRT upgrade and patients with De novo CRT under the telemedicine model showed improvement in cardiac function and disease-related cognition after remote accurate follow-up.