scholarly journals Risk assessment of cyber-attacks on telemetry-enabled cardiac implantable electronic devices (CIED)

2020 ◽  
Author(s):  
Mikaëla Ngamboé ◽  
Paul Berthier ◽  
Nader Ammari ◽  
Katia Dyrda ◽  
José M. Fernandez
Keyword(s):  
Risk Assessment ◽  
Analytical Approach ◽  
Electronic Devices ◽  
Cyber Attacks ◽  
Acceptable Risk ◽  
Cardiac Implantable Electronic Devices ◽  
Entry Points ◽  
Management Plans ◽  
The Impact ◽  
Intellectual Property Theft

Abstract Cardiac implantable electronic devices (CIED) are vulnerable to radio frequency (RF) cyber-attacks. Besides, CIED communicate with medical equipment whose telemetry capabilities and IP connectivity are creating new entry points that may be used by attackers. Therefore, it remains crucial to perform a cybersecurity risk assessment of CIED and the systems they rely on to determine the gravity of threats, address the riskiest ones on a priority basis, and develop effective risk management plans. In this study, we carry out such risk assessment according to the ISO/IEC 27005 standard and the NIST SP 800-30 guide. We employed a threat-oriented analytical approach and divided the analysis into three parts, an actor-based analysis to determine the impact of the attacks, a scenario-based analysis to measure the probability of occurrence of threats, and a combined analysis to identify the riskiest attack outcomes. The results show that vulnerabilities on the RF interface of CIED represent an acceptable risk, whereas the network and Internet connectivity of the systems they rely on represent an important potential risk. Further analysis reveals that the damages of these cyber-attacks could spread further to affect manufacturers through intellectual property theft or physicians by affecting their reputation.

scholarly journals Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Cueva-Parra ◽  
G Munoz-Benavides ◽  
W Ortiz-Solis ◽  
J Gomez-Flores ◽  
MF Marquez ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Referral Center ◽  
Funding Sources ◽  
Cardiac Implantable Electronic Devices ◽  
Electrophysiological Studies ◽  
Electrophysiological Procedures ◽  
The Impact ◽  
Large Groups ◽  
Made In ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. Objectives Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center.  Methods We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included. Results There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46). Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p < 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June. Conclusions The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.

scholarly journals Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic

2021 ◽  
Vol 10 (8) ◽  
pp. 1618
Author(s):  
Andrea Matteucci ◽  
Michela Bonanni ◽  
Marco Centioni ◽  
Federico Zanin ◽  
Francesco Geuna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hospital Admissions ◽  
Electronic Devices ◽  
Home Monitoring ◽  
Home Management ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiac Devices ◽  
The Impact

Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.

scholarly journals Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

2021 ◽  
Vol 10 (18) ◽  
pp. 4086
Author(s):  
Massimiliano Maines ◽  
Pietro Palmisano ◽  
Maurizio Del Greco ◽  
Donato Melissano ◽  
Silvana De Bonis ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Electronic Devices ◽  
Cardiac Pacing ◽  
Median Number ◽  
Temporal Perspective ◽  
Cardiac Implantable Electronic Devices ◽  
Outpatient Visits ◽  
Exponential Increase ◽  
Number Of Patients ◽  
The Impact

The COVID-19 pandemic has had a profound impact on the organisation of health care in Italy, with an acceleration in the development of telemedicine. To assess the impact of the COVID-19 pandemic on the spread of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) in Italy, a survey addressed to cardiologists operating in all Italian CIED-implanting centres was launched. A total of 127 cardiologists from 116 Italian arrhythmia centres took part in the survey, 41.0% of all 283 CIED-implanting centres operating in Italy in 2019. All participating centres declared to use RM of CIEDs. COVID-19 pandemic resulted in an increase in the use of RM in 83 (71.6%) participating centres. In a temporal perspective, an increase in the median number of patients per centre followed up by RM was found from 2012 to 2017, followed by an exponential increase from 2017 to 2020. In 36 participating centres (31.0%) a telehealth visits service was activated as a replacement for in-person outpatient visits (in patients with or without CIED) during the COVID-19 pandemic. COVID-19 pandemic has caused an acceleration in the use of RM of CIEDs and in the use of telemedicine in the clinical practice of cardiology.

scholarly journals Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial

2020 ◽  
Vol 9 (11) ◽  
pp. 3729
Author(s):  
Sławomir Pluta ◽  
Ewa Piotrowicz ◽  
Ryszard Piotrowicz ◽  
Ewa Lewicka ◽  
Wojciech Zaręba ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Remote Monitoring ◽  
Electronic Devices ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Implantable Electronic Devices ◽  
Hospitalised Patients ◽  
The Impact

Background: The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). Methods: Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) ≤40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. Results: Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p < 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p < 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189–0.686; p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). Conclusions: HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.

The analytical approach to ornithological collision risk assessment (the example of the «Boryspil» international airport)

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
I Horobtsov ◽  
◽  
M Radomska ◽  
L Cherniak ◽  
◽  
...  
Keyword(s):  
Risk Assessment ◽  
Analytical Approach ◽  
Risk Level ◽  
Flight Safety ◽  
Collision Risk ◽  
Synanthropic Species ◽  
The Family ◽  
Impact Area ◽  
And Behavior ◽  
The Impact

The paper considers issues of interaction between aviation and avifauna, relevant in terms of flight safety and safety of habitats for birds living in the impact area of ​​ airports. A number of parameters of aircraft and air traffic flow significantly affect the behavior and diversity of birds living in the respective areas. The analysis showed that species composition of avifauna at airports includes very few fully synanthropic species, while semi-synanthropes, such as members of the family Corvidae, are often found in airport areas and, due to their size and behavior, are of major hazard to aircrafts. A variety of methods for assessing the level of ornithological hazard are proposed by researchers and used in some countries. The authors presented a matrix method for assessing the risk of collisions between birds and aircraft, adapted to the conditions of Ukrainian airports. In particular, this method takes into account the peculiarities of avifauna monitoring carried out at the airports of Ukraine and the range of data on birds that may be available at these enterprises. The proposed analytical approach to ornithological risk assessment and ornithological management was tested on the example of Boryspil Airport, for which the attractiveness of the territory for birds, focal species of birds that need the most attention during ornithological observations by the airport staff, and the risk level were determined. It is necessary to expand the list of indicators according to which data should be collected during routine ornithological monitoring of airports.

scholarly journals Costs and quality of care optimization in the remote monitoring of cardiac implantable electronic devices (CIEDs). A picture from Veneto, Northern Italy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Ignatiuk ◽  
M.S Baccillieri ◽  
G Frigo ◽  
L Marinaccio ◽  
E Cassinadri ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Public Hospitals ◽  
Significant Heterogeneity ◽  
Total Expenditure ◽  
Nursing Time ◽  
Workload Analysis ◽  
Cardiac Implantable Electronic Devices ◽  
Phone Calls ◽  
The Cost ◽  
The Impact

Abstract Background Remote control/monitoring (RC/M) of cardiac implantable electronic devices (CIEDs) is still underutilized, with a significant heterogeneity of use across and within countries. Not all models are equivalent in terms of effectiveness and efficiency. Purpose This cost comparative study aimed to analyse different models of following patients with CIEDs in three districts (four implanting facilities) merged into the same administrative area, to assess the impact of RC/M on expenditure, and to propose a common practice with the objectives of standardisation of approach, optimisation of efficiency, and future capillary implementation of RC/M. Methods The workload related to CIED-patient follow-ups was assessed in four public hospitals reflecting three different models with different proportions of patients followed by RC/M and different modus operandi. All CIED-patients in charge were scrutinized at 31/08/2019. The workload analysis was based on one-year data, collected retrospectively. Costs were calculated in terms of nursing and physician hours and based on public tariffs. Five variables, identified as drivers of costs, were tested by the simulation model. The main outcome was a total expenditure and cost per patient followed by RC/M compared to the standard care (SC) (in-office only). Results A total of 6830 patients with CIEDs were followed, 34.8% by RC/M (five platforms, 19.7% high voltage devices). An additional 25.8% had monitorable devices. The proportion of RC/M-patients across centres was 63.3%, 60.6%, 51% and 2.65%. RC/M resulted more costly than SC in all hospitals. Modelling demonstrated the overall cost in the year 2018 to be €228,075. No single factor optimisation tested separately (number of transmissions, nursing time for each transmission revision, doctor time for transmission processing, nursing time for phone calls, time for single enrolment) was able to reduce the cost per patient below the cost of SC. Providing monitoring to all compatible patients increased the costs of total care to €248,785. After the optimisation of other factors, the additional benefit of extending RC/M to compatible devices was achieved, with the final result of a total expenditure of €128,181 and of €15.97 per RC/M-patient per year vs. €27.93 per SC-patient, below the reimbursement tariff of monitoring recently approved in Veneto (€25.55 per patient/year). Conclusion Real-world data from an unselected population confirmed the huge inconsistency in managing patients with CIEDs. RC/M was associated with a significant specific workload. RC/M may be cost-saving compared to the standard in-office follow-up; however, organisation needs to be optimised. Improvement can be achieved by implementing new standards for RC/M procedures using Lean Management tools. A common platform might be of help. Centralisation could represent a further step to ensure high quality service and to save money at the same time. Funding Acknowledgement Type of funding source: None

scholarly journals Electromagnetic Field Associated With Dermoscope Magnets May Affect the Safety of Cardiac Implanted Electronic Devices Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Grzegorz Sławiński ◽  
Martyna Sławińska ◽  
Zbigniew Usarek ◽  
Michał Sobjanek ◽  
Maciej Kempa ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Electromagnetic Interference ◽  
Measuring Equipment ◽  
Electronic Devices ◽  
Safe Distance ◽  
Cardiac Implantable Electronic Devices ◽  
Contact Plate ◽  
Lift Off ◽  
The Impact ◽  
The Magnetic Field

Dermoscopy is currently used as an auxiliary tool in general dermatology. Since some commercially available dermoscopes have built-in magnets, electromagnetic interference (EMI) may occur when examining cardiac implantable electronic devices (CIED) patients. The aim of the study was to create maps of electromagnetic fields defining a safe distance in terms of EMI. The study was performed in laboratory conditions using measuring equipment specially designed for this purpose. The following dermoscopes have been tested: Illuco IDS-1100, Visiomed Luminis, Visiomed Luminis 2, Heine NC2 with and without a contact plate, DermLite DL4, and DermLite Handyscope. Measurements were made for the following set of lift-off distances: 5, 10, 20, 30, 40, 50, and 150 mm. Each 2D scan consisted of 10-line scans shifted from each other by 10 mm. The strength of the magnetic field decreased with the distance from the faceplate. The distribution of the magnetic field differed depending on the position of the magnets. The highest magnetic field was recorded in the center of the Heine NC2 faceplate (up to 8 mT). In most cases, at a distance of 10 mm, the magnetic field strength was measured below 1 mT, with the exception of Heine NC2 and Heine NC2 with a contact plate. All tested dermoscopes generated a magnetic field of &lt;1 mT at the distance of 20 mm. The use of dermoscopes with built-in magnets may affect the functioning of CIEDs, and the impact may vary depending on the type of dermoscope.

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