Determinants of global cardiac implantable electrical device remote monitoring utilization – Results from an international survey

Background

Despite near-global availability of remote monitoring (RM) in patients with cardiac implantable electronic devices (CIED), there is a high geographical variability in the uptake and use of RM. The underlying reasons for this geographic disparity remain largely unknown.

Objectives

To study the determinants of worldwide RM utilization and identify locoregional barriers of RM uptake.

Methods

An international survey was administered to all CIED clinic personnel using the Heart Rhythm Society global network collecting demographic information, as well as information on the use of RM, the organization of the CIED clinic, and details on local reimbursement and clinic funding. The most complete response from each center was included in the current analysis. Stepwise forward multivariate linear regression was performed to identify determinants of the percentage of patients with a CIED on RM.

Results

A total of 302 responses from 47 different countries were included, 61.3% by physicians and 62.3% from hospital-based CIED clinics. The median percentage of CIED patients on RM was 80% (interquartile range, 40–90). Predictors of RM use were gross national income per capita (0.76% per US$1000, 95% CI 0.72–1.00, P < .001), office-based clinics (7.48%, 95% CI 1.53–13.44, P = .014), and presence of clinic funding (per-patient payment model 7.90% [95% CI 0.63–15.17, P = .033); global budget 3.56% (95% CI -6.14 to 13.25, P = .471]).

Conclusion

The high variability in RM utilization can partly be explained by economic and structural barriers that may warrant specific efforts by all stakeholders to increase RM utilization.