Remote monitoring of patients with cardiac implantable electronic devices: maximizing gains by addressing workflow

Abstract

This editorial refers to ‘Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry’ by R.P. Ricci et al. , on page 970 and ‘Incidence and predictors of pacemaker reprogramming: potential consequences for remote follow-up’ by E.O. Udo et al. , on page 978. Innovations are usually greeted guardedly, especially those demanding changes in clinical habits. When and how these should be applied are obvious questions to physicians and patients alike. Automatic remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is no exception, over a decade after its introduction. This, despite the need stated by professional societies and impressive trial data.1–3 However, diffidence in the community is reflected in slow adoption. In this issue of the Journal , two large (>1500 patients) prospective registries address some critical aspects of the operating mechanics of this technology. First, Udo et al. 4 aimed to define the candidate population for RM (although, importantly, did not actually test its application). They measured the frequency of non-actionable follow-up encounters in a large cohort of patients with pacemakers. This concept is critical—remote follow-up can only replace conventional in-person scheduled evaluation if the bulk of such appointments do not trigger any changes in patient management, i.e. are ‘non-actionable’. If, on the other hand they are frequently actionable, then discoveries from remote data download will require those patients to be contacted and brought to hospital, duplicating effort rather than promoting efficiencies. The results, however, confirmed that the vast majority (>80%) of patients studied did not need reprogramming changes (‘visits-with-reprogramming’), in keeping with conclusions from implantable cardioverter-defibrillator (ICD) trials. The authors looked at this from another vantage—whether it is possible to identify those patients at high risk of requiring management changes and assign these to …