Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow‐up

Abstract

BackgroundPatient satisfaction with remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) seems to be high, yet knowledge on long‐term patient experiences is limited. The European REMOTE‐CIED study explored patients' experiences with RPM, examined patient's preferences for ICD follow‐up, and identified determinants of patient's preferences in the first 2 years postimplantation.MethodsEuropean heart failure patients (N = 300; median age = 66 years [interquartile range (IQR) = 59‐73], and 22% female) with a first‐time ICD received a Boston Scientific LATITUDE RPM system (Marlborough, MA, USA) and had scheduled in‐clinic follow‐ups once a year. Patients completed questionnaires at 1‐2 weeks and also at 3, 6, 12, and 24 months postimplantation and clinical data were obtained from their medical records. Patient evaluation data were analyzed descriptively, and Student's t‐tests/Man‐Whitney U tests or Chi‐square tests/Fisher's exact tests were performed to examine determinants of patient preferences.ResultsAt 2 years postimplantation, the median patient satisfaction score with the RPM system was 9 out of 10 (IQR = 8‐10), despite 53% of the patients experiencing issues (eg, failure to transmit data). Of the 221 patients who reported their follow‐up preferences, 43% preferred RPM and 19% preferred in‐clinic follow‐up. Patients with a preference for RPM were more likely to be higher educated (P = 0.04), employed (P = 0.04), and equipped with a new LATITUDE model (P = 0.04), but less likely to suffer from chronic obstructive pulmonary disease (P = 0.009).ConclusionIn general, patients were highly satisfied with RPM, but a subgroup preferred in‐clinic follow‐up. Therefore, physicians should include patients’ concerns and preferences in the decision‐making process, to tailor device follow‐up to individual patients’ needs and preferences.

Findings of remote monitoring of implantable cardioverter defibrillators during the COVID‐19 pandemic

“…10 Patient satisfaction and reduced healthcare utilization/costs are other arguments in favour of remote monitoring for ICDs. 6,[12][13][14][15] While remote monitoring is a class 1 recommendation for routine follow-up of CIEDs, an annual in-person visit is still proposed due to the lack of evidence on safety with longer interval between visits. 4 Thus, recommendations during the pandemic in favour of remote monitoring for every patient irrespective of the delay since their last in-person visit are only supported by expert consensus.…”

“…Also, remote monitoring leads to more rapid clinical event detection and a reduction in inappropriate shocks 10 . Patient satisfaction and reduced healthcare utilization/costs are other arguments in favour of remote monitoring for ICDs 6,12–15 …”

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

“…With the recent EU General Data Protection Regulation, hospitals and physicians must be aware of certain rules that need to be complied with and agreements with manufacturers that need to be in place to implement remote monitoring. Finally, patients preference should be taken into account, as observational data indicates that around 20–35% of patients prefer in‐clinic visits instead of remote monitoring 154 …”

Remote monitoring of implantable cardioverter defibrillators: Aligning patient preferences and provider recommendations

“…In this issue of PACE, Timmermans et al 5 Most striking among the data presented, is that despite high levels of satisfaction with their cardiology care and remote monitoring system, nearly one in five patients reported a strong preference for clinic-based follow-up, and a similar proportion reported a desire to discontinue remote monitoring in the future. It is important to note that these data do not take into account the sizable number of eligible patients who refused the study participation (15%) because they were unwilling to be randomized to remote follow-up.…”

“…In this issue of PACE , Timmermans et al provide important information on the long‐term experiences of patients with remote monitoring, and examine the characteristics and motivations associated with patients’ preferences for routine device management. The authors analyzed survey data from 300 European heart failure patients with first‐time single‐chamber, dual‐chamber, and cardiac resynchronization therapy defibrillators who were enrolled in the REMOTE‐CIED trial.…”