Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project

Abstract

Background: This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice.Methods: A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance.Results: A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an outof-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on.Conclusions: This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.

Remote monitoring of cardiac implantable devices during COVID-19 outbreak: “keep people safe” and “focus only on health care needs”

“…Only 5 patients needed an urgent in-hospital access. The majority of alerts were related to supraventricular and ventricular arrhythmias (particularly atrial fibrillation), in agreement with what other European surveys [7,8]. For what concerns remote data related to the heart failure status, we had some alerts of low CRT%.…”

Home delivery of the communicator for remote monitoring of cardiac implantable devices: A multicenter experience during the covid‐19 lockdown

“…The safety and efficacy of RM was established a decade ago by the landmark TRUST trial, in which RM with automatic daily surveillance of ICD was able to detect actionable events more rapidly than conventional in‐office visits 15 . As also reported in several studies, not only does RM play a central role in preventing hospitalizations and improving survival and quality of life in patients with CIEDs, it is also a cost‐effective alternative to in‐person evaluations 16–25 . Overall, in the context of the COVID‐19 emergency, the improvement of RM coverage has facilitated continuous patient assistance and significantly reduced the risk of virus transmission among both more vulnerable populations and healthcare providers 26–28 …”

Long‐term outcomes after prophylactic ICD and CRT‐D implantation in nonischemic patients: Analysis from a nationwide database of daily remote‐monitoring transmissions

“…The present analysis was performed in the framework of the Home Monitoring Expert Alliance (HMEA) initiative, a nationwide repository of data collected through RM of cardiac implantable electronic devices …”