International survey of cardiac device clinic staff determining patient-perceived challenges with remote monitoring.

Background: Regular interaction with patients with cardiac implantable electronic devices (CIEDs) provides CIED clinic personnel with unique insights into patient-related barriers and challenges to remote monitoring (RM) implementation.

Methods: Using a global network, an international survey was administered to CIED clinic personnel. Qualitative questions gathered information on perceived challenges with patient connectivity and patient-level barriers associated with RM implementation.

Results: A total of 339 responses from 302 unique centres were included in the analysis. Respondents most often were cardiac electrophysiologists (57.8%), followed by nurses (17.1%) and nurse practitioners (7.7%). Most respondents (84.7%) reported at least one challenge in daily RM management. The biggest challenge was the increasing data volume and data variability (38.3%), followed by staff shortage (33.8%), difficulties with billing for technical activities (20.2%), and insufficient RM reimbursement (16.0%). Patient connectivity was identified as a major barrier by 72.7% of respondents. The main concerns were patient literacy (80.8%), followed by a lack of patient understanding of RM importance (65.8%), the lack of required bandwidth or technology to support RM (49.6%), and the cost to the patient (47.9%). Subgroup analyses showed that patient connectivity was often identified as a major barrier by non-MD CIED clinic staff, respondents working in office-based CIED clinics, and respondents from clinics with a per-patient payment reimbursement model.

Conclusions: There are many patient-related barriers identified by non-MD CIED clinic staff. Dedicated strategies to optimise the utilisation and adherence of RM of patients with CIEDs are urgently needed to improve clinical outcomes.