Impact of intensive follow-up of cardiac implantable electronic devices via remote monitoring: A pilot study

BACKGROUND: The volume of remote monitoring (RM) data generates a significant workload and is generally dealt with by clinic staff during standard office hours, potentially delaying clinical action. OBJECTIVE: The purpose of this study was to determine the clinical efficiency and workflow of implementing intensive RM (IRM) in patients with cardiac implantable electronic device (CIED) when compared with standard RM (SRM). METHODS: From a cohort of >1500 remotely monitored devices, 70 patients were randomly selected to undergo IRM. For comparison, an equal number of matched patients were prospectively selected for SRM. Intensive follow-up occurred via automated vendor-neutral software with rapid alert processing by International Board of Heart Rhythm Examiners–certified device specialists. Standard follow-up was conducted by clinic staff during office hours via individual device vendor interfaces. Alerts were categorized on the basis of the level of acuity as actionable (red [high], yellow [moderate]), or green [not requiring action]). RESULTS: Over 9 months of follow-up, 922 remote transmissions were received; 339 (36.8%) were coded as actionable alerts (118 in IRM and 221 in SRM; P < .001). The median time from initial transmission to review was 6 hours (interquartile range [IQR] 1.8–16.8 hours) in the IRM group compared with 10.5 hours (IQR 6.0–32.2 hours) in the SRM group (P < .001). The median time from transmission to review of actionable alerts in the IRM group was 5.1 hours (IQR 2.3–8.9 hours) compared with 9.1 hours (IQR 6.7–32.5 hours) in the SRM group (P < .001). CONCLUSION: Intensive and managed RM results in a significant reduction in time to review alerts and number of actionable alerts. Monitoring with enhanced alert adjudication is needed to facilitate device clinic efficiency and optimize patient care. STUDY REGISTRATION: ACTRN12621001275853