Remote monitoring: Doomed to let down or an attractive promise?

Abstract

Device interrogation and management are time consuming, representing a relevant burden for pacing centers. In several situations, patients' management requires additional follow up visits. Remote Monitoring (RM) allows an optimal recall management and a rapid diagnosis of device or lead failure, without the need of additional in office visits. Further it allows a significant delay reduction between the adverse event and the reaction to the alarm, shortening the time needed to make a clinical decision. A role in risk-predicting patient-related outcomes has also been shown. RM permits detection of the arrhythmia from 1 to 5 months in advance compared to in-office visits. Importantly, by using specific algorithms with multiparametric analysis, RM has been studied as a potential instrument to identify early patients on risk of worsening HF using specific algorithms. Although the use of RM in HF setting remains controversial, it has been proposed to improve HF clinical outcomes and survival in clinical trials. In this sense, RM success could require a standardization of process within a management model, that may involve different health care professionals. In this review, we examine recent advances of RM providing an update of this tool through different clinical scenarios.

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

“…A recent review describes the requirement of the referring nurse to be an expert in cardiac pacing and device follow-up, and a daily connection with a website should be performed to evaluate received alerts. To avoid stress and worries for the nurses, every center must define a written decision algorithm in order to standardize the handling of alerts [ 13 ].…”

“…Remote monitoring of implanted devices has been found to have a number of advantages for both patients and health care personnel, compared to office-based visits, when the connectivity and transmissions work properly [ 11 ]. For example, RPM of the ICD reduces health care costs, time consumption, as well as transportation costs for patients [ 12 , 13 ]. It also provides a feeling of security for the patients knowing that their device is constantly being monitored and if there are some functional problems, those will be detected without delay [ 14 ].…”

Cardiac Resynchronization Therapy Remote Monitoring – COVID-19 Pandemic Experiences and Future Perspectives

“…The role of remote monitoring in CRT and other cardiac implantable electronic devices (CIED) – implantable cardioverter-defibrillators (ICD) and pacemakers (PM) has been pointed out in numerous papers 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 . It has positive impact on patients’ quality of life, healthcare costs reduction and, what is the most important, clinical outcome of HF patients 5 , 6 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 .…”

“…patients’ activity or hydration prevents appropriate shocks in CRT-D 5 , 9 . What is more, with the application of specific algorithms, it could also be considered an instrument for the patients at risk of HF exacerbation identification 4 , 7 . Early detection of other arrhythmias, e.g.…”

Challenges in the remote monitoring of cardiac implantable electronic devices in 2021

“…Artificial intelligence could help in triage patients, integrating millions of records in electronic datasets. At present, this seems to be very attractive for caring of HF patients, which could benefit from remote clinical management using a multiparametric analysis of transmitted data [41]. Some examples in clinical research, already underscore the potential role of such a huge amount of data, in the field of atrial fibrillation [42].…”