Current clinical practice versus remote monitoring recommendations for cardiovascular implantable electronic devices: A real-world analysis from a remote monitoring database

Background

The recently published Consensus Statement on the Practical Management of Remote Device Clinics offers recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). They recommend activating remote monitoring (RM) soon after implantation and maintaining connectivity. Moreover, it is reasonable to replace scheduled device follow-up with alert-based RM, with alert parameters customized to clinical indications to reduce RM workload.

Objective

The purpose of this study was to evaluate current clinical practice to inform adjustments to better follow recommendations and improve use of RM.

Methods

Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 centers between 2010 and 2023 were analyzed. Median RM duration was 40 months.

Results

Patient enrollment significantly increased over the observation period. The proportion of patients enrolled within 2 weeks of implantation was 73% and within 3 months was 94%. At the time of data extraction, 14% of patients had interrupted connectivity. Scheduled device transmissions were programmed at least once every 3 months in 96% of patients for all CIED types. In 2023, 6600 in-office interrogations were performed, and 70,453 remote transmissions were reviewed. Scheduled transmissions accounted for 52% of the total, patient-initiated interrogations for 28% and alert transmissions for 20%.

Conclusion

The use of RM in clinical practice is increasing, with more in-office and remote visits. Centers are not adopting the alert-based RM strategy, which would enable them to reduce the significant burden of nonactionable remote and in-office visits.