Elizabeth A Ching

Publications (2)9.12 Total impact

• Article: Remote monitoring of cardiovascular devices: A time and activity analysis.

  Edmond M Cronin, Elizabeth A Ching, Niraj Varma, David O Martin, Bruce L Wilkoff, Bruce D Lindsay
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  ABSTRACT: BACKGROUND: Expanding indications for cardiovascular implantable electronic devices are accompanied by an increasing burden of device clinic follow-up. Remote monitoring (RM) may be less time-consuming compared to in-office follow-up; however, its effect on the device clinic workflow has not been clarified. OBJECTIVE: XXX. METHODS: Detailed workflow data were prospectively collected over a 2-week period in a busy device clinic. RESULTS: Five hundred remote transmissions were received from 434 patients between March 1 and March 16, 2011-346 implantable cardioverter-defibrillator, 84 pacemaker, and 70 implantable loop recorder transmissions-on 4 RM platforms (CareLink 56.4%, Merlin.net 21.4%, LATITUDE 17.8%, and Home Monitoring 4.4%). The mean time spent per transmission was 11.5 ± 7.7 minutes, which was less than in-person interrogations (27.7 ± 9.9 minutes; P <.01). Of 500 transmissions, 135 (27.0%) demonstrated clinically important findings; however, only 41 (8.2%) were forwarded for physician review. Of 500 transmissions, 138 (27.6%) were unscheduled, and these were more likely to contain a clinically important event (56 of 138 [40.6%] vs 79 of 362 [21.8%]; P = .0001). A total of 5.8% of the transmissions were duplicate. Transmissions that revealed clinically important findings took longer to process than those that did not (21.0 ± 7.4 minutes vs 10.1 ± 2.1 minutes; P <.05). A total of 49.2% of the scheduled remote transmissions were missed because of patient noncompliance. Telephone follow-up of patients (mean 21 patients/d) who missed scheduled remote transmissions took a mean of 55.1 (range 20-98) min/d. CONCLUSIONS: Analysis of RM transmissions has significant implications for the device clinic workflow. Nonactionable transmissions are rapidly processed, allowing clinicians to focus on clinically important findings. However, poor patient compliance complicates the workflow efficiency of currently available systems.
  Heart rhythm: the official journal of the Heart Rhythm Society 08/2012; · 4.56 Impact Factor
• Article: Implantable cardioverter-defibrillator FDA safety advisories: Impact on patient mortality and morbidity.

  Jay Sengupta, Arthur C Kendig, Marlene Goormastic, Eui-Seock Hwang, Elizabeth A Ching, Roy Chung, Bruce D Lindsay, Patrick J Tchou, Bruce L Wilkoff, Mark J Niebauer, [......], Mohamed Kanj, Mandeep Bhargava, Thomas Dresing, Tyler Taigen, Christopher Ingelmo, Mohamed Bassiouny, Edmond M Cronin, Bradley Wilsmore, John Rickard, Mina K Chung
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  ABSTRACT: A significant proportion of implantable cardioverter-defibrillators (ICDs) have been subject to Food and Drug Administration (FDA) advisories. The impact of device advisories on mortality or patient care is poorly understood. Although estimated risks of ICD generators under advisory are low, dependency on ICD therapies to prevent sudden death justifies the assessment of long-term mortality. To test the association of FDA advisory status with long-term mortality. The study was a retrospective, single-center review of clinical outcomes, including device malfunctions, in patients from implantation to either explant or death. Patients with ICDs first implanted at Cleveland Clinic between August 1996 and May 2004 who became subject to FDA advisories on ICD generators were identified. Mortality was determined by using the Social Security Death Index. In 1644 consecutive patients receiving first ICD implants, 704 (43%) became subject to an FDA advisory, of which 172 (10.5%) were class I and 532 (32.3%) were class II. ICDs were explanted before advisory notifications in 14.0% of class I and 10.1% of class II advisories. Among ICDs under advisory, 28 (4.0%) advisory-related and 15 non-advisory- related malfunctions were documented. Over a median follow-up of 70 months, 814 patients died. Kaplan-Meier 5-year survival rate was 65.6% overall, and 64.2, 61.1, and 69.3% in patients with no, class I, and class II advisories, respectively (P = .17). ICD advisories impacted 43% of the patients. Advisory-related malfunctions affected 4% within the combined advisory group. Based on a conservative management strategy, ICDs under advisory were not associated with increased mortality over a background of significant disease-related mortality.
  Heart rhythm: the official journal of the Heart Rhythm Society 07/2012; 9(10):1619-26. · 4.56 Impact Factor