Abstract 9427: The Use of Cardiac Device Remote Monitoring in the Covid-19 Era of Telehealth Outpatient Medicine

Abstract

Background and Aim: During the Covid-19 pandemic, outpatient care has utilised telemedicine reviews for cardiac follow-up. We assessed the safety of remote monitoring in context with telehealth medicine for such patients. Methods: A retrospective analysis was performed on cardiology pacing clinic patients at a hospital in Victoria, Australia, between March and September 2020. Patients were stratified into those who had face-to-face physician review, in-person cardiac technician review, and telemedicine consultation. Results: We identified 408 patients (65% male, age 65 ± 14 years), of whom 230 received telehealth consultation, 115 had technician-only reviews, and 63 had face-to-face physician review. There was no significant difference in baseline demographics. Remote monitors were used in 52% (n=120) of the telehealth cohort. Ventricular arrhythmias were seen in 1.3% (n=3) and 0.9% (n=1) during telehealth and technician review groups respectively, with none seen in the physician group (p=0.642). New atrial fibrillation (AF) was seen in 5.3% (n=12), 8.1% (n=5), and 3.5% (n=4) of groups respectively (p=0.421). Hospital admissions within one month of consultation occurred in 3.1% (n=7), 19% (n=12) and 7% (n=8) of the telemedicine review, physician review, and technician review groups respectively (p<0.001). Of the 73 patients who had cardiac devices implanted, wound issues including haematoma and infection were identified in 3.5% (n=4) of the technician interrogation cohort, 1.6% (n=1) receiving face-to-face clinician review, and none in the telemedicine cohort (p=0.021).We identified 1.8% (n=4), 6.5% (n=4) and 8% (n=7) of patients who had reached elective replacement interval (ERI) in telemedicine, physician review and technician reviews respectively (p=0.036). Conclusion: Our study demonstrated no difference in detection of new AF or ventricular tachyarrhythmias between telemedicine and face-to-face consultations. Contrastingly, telemedicine reviews were associated with reduced detection of ERI, less detection of wound complications, compared to patients receiving in-hospital device interrogation. Randomised studies are required to determine the true impact of telemedicine on these outcomes.