Abstract 12781: Trends in Remote Monitoring for Patients With Hf and Identification of Opportunities to Expand Rural Access

Abstract

Introduction: Limited access, due to geographic and/or transportation barriers, is one of the most significant challenges to chronic disease management in rural areas. Remote monitoring is a potential solution that allows a patients’ implanted devices to be interrogated for arrhythmia and non-invasive hemodynamics without the patient travelling to clinic. The aim of this study is to describe recent trends in remote monitoring among patients with HFrEF and to identify barriers and expand access in rural areas. Methods: We created annual, cross-sectional cohorts of patients with HF in each year from 2013 to 2018 with approximately 5 million patients/year by requiring ≥1 inpatient or ≥2 outpatient ICD9/10 codes for HF in the 2 years prior. Remote interrogation was determined using ICD-9/10 and CPT codes. Rurality was determined using the beneficiaries’ ZIP code of residence and the Rural/Urban Commuting Areas (RUCA) classification. The outcome of interest was the number of HFrEF patients with ≥1 remote monitoring visit in each year between 2013 and 2018. Results: The use of remote monitoring increased 21% between 2013 and 2018 in patients with HFrEF. By 2018, 9.3% of patients had ≥1 remote monitoring event (Figure 1). After multivariable adjustment for patient factors, living in a rural area was associated with a 14% greater odds (95% CI 1.13, 1.14, p<0.001) of remote monitoring. However when hospital referral region (HRR), a geographic delineation of health care markets, was added to the model, living in an urban area became associated with a 7.8% greater odds of remote monitoring (95% CI 1.07, 1.08, p<0.001). Conclusion: Remote monitoring is used by approximately 10% of patients with HFrEF. The most significant driver of remote monitoring is the HRR, or health care market, that the beneficiary resides in. To increase remote monitoring for rural patients, hospitals in predominately rural HRR’s should be incentivized to expand remote monitoring services.