The significant increase in the number of ICD follow-up checks over the past three years has greatly impacted my clinic s schedules, staff and space requirements. For the year 2000, Stern Cardiovascular Center in Memphis, Tennessee recorded 375 ICD patient follow-up checks. As a result of broadened indications for defibrillator implants, the number of follow-up checks grew to 942 in 2001, and then to 1,305 in 2002. We are projected to exceed 1,645 by the end of 2003 a more than 430% increase over a period of three years. During the same period, pacemaker follow-up visits have grown by 32%. One of the strategic changes we made last year was to implement the Medtronic (Minneapolis, Minnesota) CareLink Network, an Internet-based remote monitoring service for Medtronic cardiac device patients. The challenge was to manage the growing number of new device patients impacting our clinic and cut down on the congestion in our office, while also providing timely and efficient, quality care for our patients. Nearly one year after implementation, we are able to report on significant benefits gained both by our clinic and by our Medtronic device patients. The Pacer/Arrhythmia staff of four nurses (myself included), one certified cardiac technologist and two technicians are engaged on several fronts every day. We presently follow approximately 3,000 cardiac device patients approximately 70% pacemaker patients and 30% ICD patients. Our pacemaker patients are followed twice a year on average; ICD patients are followed four times a year. Some patients return to their referring cardiologists after their first post-implant check at our clinic. A small number of patients are non-compliant with the recommended follow-up schedule. Our two electrophysiologists, Eric Johnson, MD and Mark Coppess, MD (2 of 15 heart specialists at Stern Cardiovascular Center) perform pacemaker and ICD implants, EP studies, ablations, and tilt table studies. Both doctors practice at the EP labs of two affiliated hospitals, Baptist Hospital Memphis and St. Francis Hospital, which are in close proximity to our office. At the present time our two electrophysiologists perform 10-15 new device implants per week, along with an ever-increasing number of procedures. With only one day of clinic time scheduled for each doctor per week at the Pacer/Arrhythmia Clinic, the number of scheduled appointments available to patients in our office has been cut down as well, placing an even greater share of the responsibility for device follow-up on our staff. On a daily basis, we perform approximately 20-30 device checks on both pacemakers and defibrillators. For in-office device interrogations, we use the programmers designed for the different devices by the manufacturers. We handle numerous event monitor transmissions that vary in quantity from day to day, and 40-50 transtelephonic monitoring (TTM) transmissions. In addition, we do an enormous amount of troubleshooting via the telephone, as well as in the office, when patients need to immediately be seen in the clinic. Since we started the progressive implementation of the Medtronic CareLink Network in October of 2002, this remote device monitoring service has been prescribed for nearly 100 of our Medtronic ICD patients. Our nursing staff takes turns training newly enrolled patients on how to use the CareLink monitor, a portable device used to transmit their device data via a standard phone line. At our directive, patients can transmit their device data from anywhere within the 50 states with this prescription device. We then download the data from the secure CareLink clinician website via the Internet, interpret the information, and prepare a formal report for physician overread and signature. Each device patient typically follows a schedule of four follow-up checks per year. With the CareLink Network, we currently obtain patient data remotely for two of the four visits or the equivalent of 200 in-office visits per year. On average, each remote follow-up visit saves one hour of collective clinic staff time. The saved time is quickly and gratefully reallocated for new patient consults, procedures and unscheduled work-ins. This has made a significant impact on how our clinic operates and the service we can provide. We instruct our enrolled patients to transmit via the CareLink monitor before noon on their scheduled dates. That allows us to handle any problems that may be discovered before the end of the day. We are able to review the transmissions in the afternoon and make any necessary phone calls to the physician and the patient about medication changes, office appointments, etc. The comprehensive information transmitted by the CareLink Network is comparable to an in-office interrogation, allowing us to review episode reports and therapy delivered by the device, parameter settings, such as a 10-second EGM, battery and lead status reports, etc. The CareLink interrogations have been especially helpful to us when patients experience problems between office visits, such as shocks, battery voltage issues, and charge time issues. Being able to review events that have caused patients to receive therapies allows our staff to either know what to expect when the patient arrives at the office, or to totally eliminate a visit altogether. In either case, quickly giving the patient information lets them understand the situation and helps to calm nerves. We are frequently able to change medications via a phone call or instruct patients to bypass our office and go straight to the emergency room if our physicians deem it necessary. If the patient goes to the ER, we are often able to transmit their CareLink report to satellite hospitals to be instantly available for emergency care. The CareLink Network takes advantage of the speed and power of the Internet to help us provide timely and efficient care to these patients. One of the best measures of our clinic s success with the Medtronic CareLink Network is the satisfaction our patients have expressed with this cutting-edge technology. Without exception, newly enrolled patients are pleasantly surprised by the monitor s ease-of-use. One of our long-distance patients compares using the monitor to simply pushing a button and holding a mouse over your device. Many of our patients who live in the outlying areas of Arkansas, Mississippi, Missouri and Tennessee the four-state area we serve frequently drive 2-3 hours to come to the office. They especially appreciate the convenience of transmitting with the monitor from the comfort of their homes in less than five minutes, and being able to eliminate extended travel, traffic issues in and around Memphis, congested parking, and time spent waiting in our office. Some patients also mention feeling free to travel away from home when they haven t been able to previously. Two recent situations illustrate the advantages of remote monitoring with the CareLink Network for individual patients. After one of our local Memphis patients suffered a complicated leg break earlier this year, he found himself immobilized at home for several months. When he suddenly experienced episodes of fast heart rhythm, he called our clinic and transmitted his device data. We reassured him within 30 minutes that the episodes were not caused by life-threatening ventricular tachycardia (VT) but by atrial fibrillation (AF). The AF episodes, a new diagnosis revealed for the first time by the CareLink interrogation, could now be treated without an office visit. Another patient, who lives in Mississippi 100 miles away from the clinic and spends almost one whole day getting to and from our office, received a therapeutic shock from his device while riding a tractor mower this summer. After he transmitted his data, we were able to reassure him right away that his device had delivered appropriate therapy in response to an episode of VT. Like many other CareLink users, this patient and his wife feel they can take trips again. With the portable CareLink monitor, they can be in contact with our clinic anytime, anywhere. As we continue to expand the CareLink remote monitoring service for our growing device patient population, we hope to ease our frequently congested schedule even further to accommodate the growing number of new device patients and perform key procedures. The Medtronic CareLink Network reassures our patients that we are doing everything possible to keep in touch with them. Working closely with patients on a daily basis, meeting their needs, relieving their fears, answering questions and being the advocate for the patient and family that is the most rewarding part of my job. This Internet-based remote monitoring tool helps me achieve that.