Abstract
Background: Remote monitoring (RM) of pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) reduces the need for in-office visits, of particular importance to patients in rural areas. Whether adoption of RM varies by geography is unknown. Objective: To evaluate geographic variability in the use of RM among Medicare beneficiaries. Methods: Medicare carrier files (2012-2015) were queried for RM and in-office professional claims of PM or ICD interrogations. Patient location was identified using residence ZIP code. Geographic variability was assessed using standard deviation of county-based proportion of RM vs in-office interrogations. We also assessed the relationship between counties’ proportional use of RM and population density. Results: Across the US, the proportion of remote to in-office interrogations increased from 2012-15 for both PMs (18.5% to 27.6%, 420,480/2,269,305 to 682,200/2,476,100) and ICDs (31.4% to 33.8%, 440,130/1,401,350 to 466,605/1,380,380) (FIGURE). However, marked variability across counties was noted, with the standard deviation of the proportion of RM ranging from 16.8-17.9% by year and device type. Significant county-to-county variability in the rate of change in proportion of RM from 2012 to 2015 was also observed (standard deviation of 2012-15 change in proportion of RM: 11.8% for PMs; 14.1% for ICDs). Population density accounted for only 1.7-4.6% of observed variability in RM utilization over time (PM: r=0.20; ICD: r=0.19; p<0.001). Conclusion: Counties varied widely in their relative use of RM and rate of adoption over time, yet population density accounted for just a small fraction of RM use variability. These findings suggest a need to target rural populations for adoption of this technology.
Published Version
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