VENTRICULAR ASSIST DEVICES PROVIDE SEVERAL LIFESAVING THERAPIES TO PATIENTS WHO SUFFER FROM HEART FAILURE AND WHERE HEART DONOR IS NOT AVAILABLE. THERE ARE SEVERAL VENTRICULAR ASSIST DEVICES PRESENTLY AVAILABLE IN THE MARKET. FOR INSTANCE, IN 2020, ABBOTT RECEIVED FDA APPROVAL FOR ITS UPDATED LABELING OF THE HEARTMATE-3 VENTRICULAR ASSIST DEVICE TO BE USED IN PEDIATRIC PATIENTS WITH ADVANCED REFRACTORY LEFT VENTRICULAR HEART FAILURES. FURTHER, THE GROWING GERIATRIC POPULATION HAVE INCREASED THE PREVALENCE OF CARDIOVASCULAR DISEASES AS OLD PEOPLE ARE MORE PRONE TO THESE DISEASES. ACCORDING TO THE UNITED STATES DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS, GLOBALLY THERE WERE 727 MILLION PEOPLE AGED 65 YEARS OR MORE IN 2020. ADDITIONALLY, THE SHARE OF THE GLOBAL POPULATION AGED 65 YEARS OR ABOVE IS EXPECTED TO INCREASE FROM 9.3% IN 2020 TO 16% BY 2050. SEVERAL ADVANCEMENTS HAVE TAKEN PLACE FOR MODIFYING VENTRICULAR ASSIST DEVICES IN RECENT YEARS SUCH AS DYNAMIC PACEMAKING, MICROPROCESSOR-CONTROLLED DEVICES, AND TRANSITIONAL TISSUE WELDING, ETC. FOR EXAMPLE, ABIOMED IN 2020, RECEIVED APPROVAL FROM THE MINISTRY OF HEALTH, LABOUR AND WELFARE (MHLW) FOR ITS IMPELLA CP A VENTRICULAR ASSIST DEVICE IN JAPAN.
THE COVID-19 PANDEMIC HAS IMPACTED ALL INDUSTRIES IN DIFFERENT WAYS, INCLUDING MEDICAL DEVICES. THE INTENSIVE, INTERMEDIATE, AND EMERGENCY CARE UNITS IN SEVERAL HOSPITALS HAVE BEEN CONVERTED TO COVID CARE UNITS. MANY HOSPITALS RESCHEDULED THEIR HEART-RELATED SURGERIES. NUMEROUS COMPANIES OFFERING VENTRICULAR ASSIST DEVICES SUFFERED HUGE LOSSES. FOR INSTANCE, MEDTRONIC, ABBOTT, AND BOSTON SCIENTIFIC CORPORATION OBSERVED A DROP IN THEIR CARDIAC RHYTHM & HEART FAILURE SEGMENT BY 12.1%,10.73%, AND 12.12%, RESPECTIVELY, IN 2020. THESE FACTORS NEGATIVELY IMPACTED THE VENTRICULAR ASSIST DEVICE MARKETS.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR THE DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
AS SHOWN IN FIG 1. ?E UNDERLYING TECHNOLOGIES ARE SEEN
AS A BLACK BOX TO THE USERS AND THEY ARE RESPONSIBLE FOR
FACILITATING PROCESSES OF EACH PROPOSED SERVICE
.......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...........
....................................... ................................
EDUCATION AND PRACTICE FUNDAMENTALS
" INTRODUCTION TO THE PRACTICE OF TELEMEDICINE
JOHN CRAIG* AND VICTOR PATTERSON*
W
?
DEPARTMENT OF NEUROLOGY, ROYAL VICTORIA HOSPITAL, BELFAST, UK;
W
CENTRE FOR ONLINE HEALTH, UNIVERSITY OF QUEENSLAND, BRISBANE,
AUSTRALIA
SUMMARY
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE AND THE EXCHANGE OF HEALTH-CARE INFORMATION ACROSS DISTANCES. IT IS NOT
A TECHNOLOGY OR A SEPARATE OR NEW BRANCH OF MEDICINE. TELEMEDICINE EPISODES MAY BE CLASSI?ED ON THE BASIS OF:
(1) THE INTERACTION BETWEEN THE CLIENT AND THE EXPERT (I.E. REALTIME OR PRERECORDED), AND (2) THE TYPE OF
INFORMATION BEING TRANSMITTED (E.G. TEXT, AUDIO, VIDEO). MUCH OF THE TELEMEDICINE WHICH IS NOW PRACTISED IS
PERFORMED IN INDUSTRIALIZED COUNTRIES, SUCH AS THE USA, BUT THERE IS INCREASING INTEREST IN THE USE OF TELEMEDICINE
IN DEVELOPING COUNTRIES. THERE ARE BASICALLY TWO CONDITIONS UNDER WHICH TELEMEDICINE SHOULD BE CONSIDERED:
(1) WHEN THERE IS NO ALTERNATIVE (E.G. IN EMERGENCIES IN REMOTE ENVIRONMENTS), AND (2) WHEN IT IS BETTER THAN
EXISTING CONVENTIONAL SERVICES (E.G. TELERADIOLOGY FOR RURAL HOSPITALS). FOR EXAMPLE, TELEMEDICINE CAN BE EXPECTED
TO IMPROVE EQUITY OF ACCESS TO HEALTH CARE, THE QUALITY OF THAT CARE, AND THE EF?CIENCY BY WHICH IT IS DELIVERED.
RESEARCH IN TELEMEDICINE INCREASED STEADILY IN THE LATE 1990S, ALTHOUGH THE QUALITY OF THE RESEARCH COULD BE
IMPROVED - THERE HAVE BEEN FEW RANDOMIZED CONTROLLED TRIALS TO DATE.
INTRODUCTION
ONE OF THE GREAT CHALLENGES FACING HUMANKIND IN THE
21ST CENTURY IS TO MAKE HIGH-QUALITY HEALTH CARE AVAILABLE
TO ALL. SUCH A VISION HAS BEEN EXPRESSED BY THE WORLD
HEALTH ORGANIZATION (WHO) IN ITS HEALTH-FOR-ALL STRATEGY
IN THE 21ST CENTURY.
1
REALIZING THIS VISION WILL BE DIF?CULT,
PERHAPS IMPOSSIBLE, BECAUSE OF THE BURDENS IMPOSED ON
A GROWING WORLD POPULATION BY OLD AND NEW DISEASES,
RISING EXPECTATIONS FOR HEALTH, AND SOCIOECONOMIC
CONDITIONS THAT HAVE, IF ANYTHING, INCREASED DISPARITIES IN
HEALTH STATUS BETWEEN AND WITHIN COUNTRIES.
TRADITIONALLY, PART OF THE DIF?CULTY IN ACHIEVING
EQUITABLE ACCESS TO HEALTH CARE HAS BEEN THAT THE
PROVIDER AND THE RECIPIENT MUST BE PRESENT IN THE SAME
PLACE AND AT THE SAME TIME. RECENT ADVANCES IN
INFORMATION AND COMMUNICATION TECHNOLOGIES,
HOWEVER, HAVE CREATED UNPRECEDENTED OPPORTUNITIES FOR
OVERCOMING THIS BY INCREASING THE NUMBER OF WAYS THAT
HEALTH CARE CAN BE DELIVERED. THIS APPLIES BOTH TO
DEVELOPING COUNTRIES WITH WEAK OR UNSTABLE ECONOMIES
AND TO INDUSTRIALIZED COUNTRIES. THE POSSIBILITIES FOR
USING INFORMATION AND COMMUNICATION TECHNOLOGIES TO
IMPROVE HEALTH-CARE DELIVERY ( HEALTH TELEMATICS ) ARE
INCREASINGLY BEING RECOGNIZED. THE WHO HAS STATED THAT
WITH REGARD TO ITS HEALTH-FOR-ALL STRATEGY IT RECOMMENDS
THAT THE WHO AND ITS MEMBER STATES SHOULD:
INTEGRATE THE APPROPRIATE USE OF HEALTH TELEMATICS IN
THE OVERALL POLICY AND STRATEGY FOR THE ATTAINMENT OF
HEALTH FOR ALL IN THE 21ST CENTURY, THUS FUL?LLING THE
VISION OF A WORLD IN WHICH THE BENE?TS OF SCIENCE,
TECHNOLOGY AND PUBLIC HEALTH DEVELOPMENT ARE MADE
EQUITABLY AVAILABLE TO ALL PEOPLE EVERYWHERE.
2
SUCH A COMMITMENT TO IMPROVE HEALTH-CARE DELIVERY,
BY UTILIZING INFORMATION AND TELECOMMUNICATIONS
TECHNOLOGIES, IS ALSO BEING CONSIDERED BY THOSE WITH THE
?NANCIAL MEANS TO DO SO, FOR EXAMPLE, THE PARTICIPANTS
IN VARIOUS EUROPEAN COMMISSION PROJECTS. AT THE
NATIONAL AND SUBNATIONAL LEVEL, THERE IS ALSO EVIDENCE OF
GOVERNMENTAL INTEREST IN THE BENE?TS THAT THESE
TECHNOLOGIES MIGHT BRING TO HEALTH CARE. FOR EXAMPLE,
IN THE UK, INFORMATION TECHNOLOGY INCLUDING
TELEMEDICINE IS AT THE HEART OF THE GOVERNMENT S
STRATEGY TO MODERNIZE AND IMPROVE THE NHS.
3
TELEMEDICINE, THE AREA WHERE MEDICINE AND INFOR-
MATION AND TELECOMMUNICATIONS TECHNOLOGY MEET, IS
PROBABLY THE PART OF THIS REVOLUTION THAT COULD HAVE THE
GREATEST IMPACT ON HEALTHCARE DELIBASED ON SERVICE, THE MARKET IS FRAGMENTED INTO TELE-CONSULTING, TELE-MONITORING, AND TELE-EDUCATION. THE TELE-CONSULTING SEGMENT GENERATED MORE THAN 45% REVENUE IN 2020. THE MARKET IS EXPECTED TO GROW AT A SIGNIFICANT RATE DURING THE FORECAST PERIOD. AS IT PERMITS PATIENTS TO HAVE APPOINTMENTS WITH EXPERTS AT ANY INSTANCE OF TIME, WITHOUT ANY WAITING PERIOD.
BASED ON PRODUCTS, THE MARKET IS BIFURCATED INTO LEFT VENTRICULAR ASSIST DEVICES (LVADS), RIGHT VENTRICULAR ASSIST DEVICES (RVADS), BIVENTRICULAR ASSIST DEVICES (BIVADS), PERCUTANEOUS VENTRICULAR ASSIST DEVICES (PVADS), AND TOTAL ARTIFICIAL HEART (TAH). THE LEFT VENTRICULAR ASSIST DEVICES (LVADS) SEGMENT DOMINATED THE MARKET IN 2020. LEFT VENTRICULAR ASSIST DEVICES (LVADS) ARE IMPLANTED IN PATIENTS WITH HEART FAILURE AND HELPS THE BOTTOM LEFT CHAMBER OF THE HEART (LEFT VENTRICLE) PUMP BLOOD OUT OF THE VENTRICLE TO THE AORTA AND THE REST OF THE BODY. BASED ON APPLICATION, THE MARKET IS BIFURCATED INTO DESTINATION THERAPY, BRIDGE-TO-CANDIDACY (BTC) THERAPY, BRIDGE-TO-TRANSPLANT (BTT) THERAPY, BRIDGE-TO-RECOVERY (BTR) THERAPY, AND OTHERS. THE DESTINATION THERAPY SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020.
BASED ON FLOW, THE MARKET IS BIFURCATED INTO THE CONTINUOUS FLOW AND PULSATILE FLOW. THE CONTINUOUS FLOW SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020, OWING TO ITS SMALLER SIZE, LONGER DURABILITY, HIGHER ENERGY EFFICIENCY, LESS THROMBOGENICITY, AND LESS SURGICAL TRAUMA. BASED ON DESIGN, THE MARKET IS BIFURCATED INTO TRANSCUTANEOUS AND IMPLANTABLE. THE IMPLANTABLE SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. THE IMPLANTABLE VENTRICULAR ASSIST DEVICES ARE MOSTLY USED BY PATIENTS WHO ARE NOT ELIGIBLE FOR A HEART TRANSPLANT TO INCREASE THE PREFERENCE FOR LONG-TERM TREATMENT METHODS AND INCREASES THEIR CHANCES OF SURVIVAL. BASED ON END-USER, THE MARKET IS BIFURCATED INTO HOSPITALS & CARDIAC CENTERS, AMBULATORY SURGICAL CENTERS, AND OTHERS. THE HOSPITALS & CARDIAC CENTER SEGMENT IS ANTICIPATED TO OBSERVE LUCRATIVE GROWTH.
FOR A BETTER UNDERSTANDING OF THE DEVICE ADOPTION, THE REPORT PROVIDES DETAILED ANALYSIS FOR MAJOR REGION INCLUDING NORTH AMERICA (US, CANADA, AND THE REST OF NORTH AMERICA), EUROPE (GERMANY, FRANCE, ITALY, SPAIN, UK, AND REST OF EUROPE), ASIA-PACIFIC (CHINA, JAPAN, INDIA, AUSTRALIA, AND REST OF APAC), AND REST OF WORLD. NORTH AMERICA CONSTITUTES A MAJOR MARKET FOR VENTRICULAR ASSIST DEVICES AND GENERATED MAXIMUM REVENUE IN 2020. SOME OF THE MAJOR PLAYERS OPERATING IN THE MARKET INCLUDE MEDTRONIC PLC, ABBOTT LABORATORIES, BERLIN HEART GMBH, RELIANT HEART INC., ABIOMED INC., TERUMO CORPORATION, ANGIODROID, SYNCARDIA SYSTEMS, CARDIACASSIST, INC., GETINGE, ETC.
