B-PO03-065 ASSESSING THE CLINICAL UTILITY OF SCHEDULED REMOTE ICD MONITORING

Abstract

Remote ICD monitoring includes scheduled, patient-initiated, and alert-driven transmissions. High transmission volume raises questions about the utility of scheduled remote interrogations in identifying actionable findings. To evaluate the incidence of and patient-level factors associated with clinically actionable findings identified through scheduled ICD remote monitoring transmissions. We identified patients receiving de novo ICDs at a single academic medical center (Jan 2016 - Dec 2019) with at least 1 year of follow-up care. We collected patient- and device-specific data at time of implant and adjudicated all remote and in-person interrogations for clinically actionable findings based on pre-specified criteria. Of 305 patients who received ICDs (71% male, mean age 62+15 years), ICD implants included single (43%), dual (27%), BiV (26%), and subcutaneous (5%). At implant 45% had CAD; 26% had AF/AFL with median CHADS2VASC of 3 (2-4); 30% were on OAC; and 76% had a history of heart failure - 64% with LVEF<40%. There was a median of 13 (25%-75% IQR, 10-16) interrogations per patient during a follow-up period of 28 (25%-75% IQR, 20-41) months. Overall, 84% of all interrogations were scheduled, 6% alert- or symptom-driven, and 10% performed for other indications. Remote transmissions accounted for 55% of all interrogations, of which 95% were scheduled. Among these, only 4.4% contained clinically meaningful findings, primarily detection of new/recurrent arrhythmia (75%) and ATP/shocks delivered (28%). Of these 4.4%, only 20% led to additional patient contact in the form of a phone call or in-person evaluation; 7% prompted changes in anti-arrhythmic, rate control, and/or anticoagulant medications. Overall, actionable findings were rarely detected on scheduled remote ICD interrogations. Significant findings predominantly involved identification and treatment of arrhythmias. Further studies are needed to determine the optimal frequency of routine, scheduled remote ICD monitoring.