Abstract
Introduction: Insertable Cardiac Monitors (ICM) aid in the diagnosis and monitoring of arrhythmias, however, reviewing the data is labor intensive and time consuming. Hypothesis: We hypothesized that new algorithms (ALG) and indication tailored programming (ITP) could reduce device-based alerts and clinician review time. Methods: Baseline data was obtained from a real-world de-identified Reveal LINQ TruRhythm ICMs database. The arrhythmia alerts and manual transmissions per patient/month was queried in this Control Group of patients with ≥3 months of follow-up. The effect of ALG and ITP was computed and applied to the Control Group. For practical purposes, the results were extrapolated to a 200 ICM clinic. Annualized clinic review time was estimated by assuming the staff time per transmission was 12.9 min., based on prior study. ALG improvements included: 1) Reject noise, loss of contact, and small R-waves for Pauses, 2) Require rapid onset for Tachy, 3) Limit nighttime episodes for Brady, and 4) Eliminate manual patient transmissions. ITP changes included: 1) Patients without Syncope: Pause ≥ 5 sec., Brady ≥ 12 beats and not during night, 2) Patients for AF Monitoring: AF ≥ 6 min. Results: The dataset consisted of 248,603 ICMs inserted for Syncope (36%), AF Diagnosis (35%), AF Monitoring (17%), and Other (12%) with an avg. of 1.1 years of follow-up (total 265,938 yrs). Applied to a 200 ICM clinic size, ALG and ITP reduced arrhythmia alerts by 32% (Control: 2,445 to ALG and ITP: 1,655 per clinic/yr). Using the new data transmission scheme eliminated 360 manual transmissions per clinic/yr.(Panel A) In total, the projected annual transmission volume (alerts + manuals in Panel A) and corresponding clinic review time (Panel B) dropped by 41% (247 hrs/yr = 13.1% full-time employee). Conclusion: Improved ALG and ITP can significantly reduce the volume of ICM alerts and consequently clinician review time impacting the management efficiency of this patient population.
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