Abstract 9265: Real-World Disparities in Remote Follow-Up of Cardiac Implantable Electronic Devices and Impact of the Covid-19 Pandemic: A Single Center Experience

Abstract

Introduction: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in utilization and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in CIED RM. Methods: Retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted CIED or device upgrade between 01/17 to 12/20 were included. Patients were classified as RM positive when they underwent at least ≥2 remote interrogations per year during follow-up. Results: Of all eligible patients, 2520 patients were included and 35% were female. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, while 26% were ICDs, and 8% CRT-Ds. Most patients (83%) were White non-Hispanic (WNH) patients. During follow-up, 66% of patients were classified as RM positive. In an adjusted regression model, these patients were younger (p=0.025) and more frequently had an ICD (HR=1.68; p<0.001). RM positive patients more frequently had an advanced college degree (HR=1.27; p=0.026) and used the online patient portal (HR=2.22; p<0.001). They lived in counties with higher median income (p=0.040) and were more frequently WNH patients (p=0.002). In a Cox regression analysis, RM status was associated with death (HR=0.487, p<0.001, Figure). During the years of the COVID-19 pandemic, RM positive patients increased and influence of income and race decreased. Conclusions: Despite being offered to all patients at implantation, significant disparities were present in CIED RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center and patient specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.