In May 2023, Heart Rhythm Society released an expert consensus statement that provided best practices for remote monitoring programs. The new statement placed emphasis on the importance of patient engagement, data management, and adequate staffing. The guidelines were updated from the previous 2015 version, which first identified remote monitoring as a class 1a recommendation and the standard of care for managing cardiac devices.
As monitoring technology and best practices have evolved over the past decade, new research proving the value of monitoring and offering solutions to optimize it continue to emerge. Explore the articles below for the latest research in the field of remote cardiac monitoring.
NOTE: You may need a subscription to access some content on external industry websites.
Expert Consensus Statement and Remote Patient Monitoring Guidelines
Kevin Hoffman
May 12, 2024A few of the most important key takeaways from the Heart Rhythm Society’s presentation of the Expert Consensus Statement
Read Full Article >
Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation
Mittal et al. (2016)
May 12, 2024This study found that prompt enrollment in remote monitoring following device implantation is associated with greater survival than delayed enrollment. Patients across all device types enrolled within 3 months of implantation had an 18% increased survival rate compared to patients enrolled past the 3-month mark.
Resource Use and Economic Implications of Remote Monitoring With Subcutaneous Cardiac Rhythm Monitors
Afzal et al. (2021)
May 12, 2024Implantable loop recorders produce a significant amount of false-positive data, but the demand on staff time and resources can be dramatically reduced when devices are reprogrammed based on clinical indication; the study found that customizing device programming reduced staff resource consumption for device interrogation by 34%.
The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients
Varma et al. (2015)
May 12, 2024From a dataset of about 300,000 patients, this study found that a greater level of adherence to remote monitoring was associated with a greater survival rate. This trend persisted across all device types; was not influenced by gender, age, or socioeconomic status; and highlights the importance of maintaining high patient connectivity.
Validation of an Organizational Management Model of Remote Implantable Cardioverter-Defibrillator Monitoring Alerts
Guédon-Moreau et al. (2015)
May 12, 2024Many device clinics struggle to prioritize urgent alerts in a way that is efficient and improves clinical outcomes. This study shows that using decision trees as an organizational model to manage alerts decreased staff time dedicated to remote monitoring by >50%, decreased actionable alerts by 21% per patient, and reduced unnecessary medical interventions in response to alerts by 60%.
Patient Preferences for Additional Health Care Information and Participation in Shared Decision Making in an Outpatient Cardiac Electrophysiology Clinic
Gonzalez et al. (2023)
May 12, 2024Among patients in an outpatient EP clinic, this study investigated patient preferences for participation in shared decision-making for their care. Independent of age or education level, the study found that 76% of participants wished to know most or all information about their condition, and 52% preferred to participate in their own care.
Standardizing alert programming across vendors in an implantable loop recorder patient cohort to reduce alert and clinic staff burden: A Pilot 2-week analysis study
Ferrara (2023)
May 12, 2024Remotely monitoring implantable loop recorders (ILRs) creates a significant alert burden for device clinic staff. This study sought to reduce that burden by programming similar ILR alerts per diagnosis across vendors using a template to standardize alerts. Programming alerts in this way led to a 66% reduction in the raw number of combined alerts from all vendors, supporting further evaluation of this method for reducing ILR alert burden.
Optimizing Remote Monitoring Alerts for CIED Patients to Reduce Resource Utilization Without Compromising Clinical Care
Gupta et al. (2023)
May 12, 2024This study evaluated the work burden associated with remote monitoring and found that a minority of patients (20%) generated the majority of alerts (65%). The authors proposed reprograming off non-clinically actionable and redundant alerts or customizing alerts to patients' diagnoses to alleviate the burden.
Impact of Patient Access to Atrial Fibrillation Burden Data Detected Via Insertable Cardiac Monitor
Mittal et al. (2023)
May 12, 2024In this study, patients undergoing ICM remote monitoring were given access to their atrial fibrillation burden data. Patients with access to their data reported having more informed conversations with their providers, suggesting that access increased their engagement with their care and agency over their health.
Failure of Implantable Cardiac Monitor Connectivity: Lessons Learned and Implications for Clinical Care
Bhatt et al. (2023)
May 12, 2024Maintaining high patient connectivity is a significant challenge in remote cardiac monitoring, but little is known about how different transmission methods impact daily connectivity. Despite the recent push to adopt bluetooth, this study found that using a bedside monitor was much more reliable for maintaining connectivity than a bluetooth-enabled smartphone app.
Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry
Ricci at al. (2013)
May 12, 2024The HomeGuide Registry was the first large registry that provided a model for implementing CIED remote monitoring in daily clinical practice. The study demonstrated that remote monitoring was highly effective in detecting clinical events without dramatically increasing outpatient resource consumption.
A mobile app for improving the compliance with remote management of patients with cardiac implantable devices: a multicenter evaluation in clinical practice
Lavalle et al. (2022)
May 12, 2024In this study, patients used an app that provided easy-to-follow instructions for getting and staying connected to their monitors and notified them of disconnection, scheduled transmissions, and battery status. Patients who used the app demonstrated greater connectivity over time than those who did not.
Scheduled versus alert transmissions for remote follow-up of cardiac implantable electronic devices: Clinical relevance and resource consumption
Maines et al. (2021)
May 12, 2024When looking at scheduled vs. alert transmissions, this study found that scheduled transmissions generated the majority of data review and consumed significant clinic resources without detecting many clinical events. Since alerts detected most clinical events, monitoring for alerts only could be sufficient and would reduce workload.
Role of patient education in the perception and acceptance of home monitoring after recent implantation of cardioverter defibrillators: The EDUCAT study
Laurent et al. (2014)
May 12, 2024This study found that educating recent ICD recipients on the monitoring process increased acceptance of monitoring and that younger patients had better comprehension of the process than older patients. The study also found that a higher level of comprehension was associated with lower anxiety and greater acceptance of monitoring.
Remote Patient Monitoring: What Have We Learned and Where Are We Going?
Vandenberk, Raj (2023)
May 12, 2024This review of the remote cardiac monitoring literature focuses on recent evolutions in the field and identifies future needs to improve it. It covers the benefits of remote monitoring, practical considerations, challenges, and future directions.
Alert-Based ICD Follow-Up: A Model of Digitally Driven Remote Patient Monitoring
Varma, Love, Michalski, Epstein (2021)
May 12, 2024Managing transmission volume is a significant challenge for device clinics. This study demonstrated that remote monitoring could dramatically reduce non-actionable alerts compared to conventional care without diminishing the ability to detect critical alerts. Further, monitoring improved follow-up adherence and detected urgent clinical events significantly earlier than conventional care.
HRS White Paper on interoperability of data from cardiac implantable electronic devices (CIEDs)
Slotwiner, et. al. (2019)
May 12, 2024Despite cardiac devices delivering similar functionality, the data each manufacturer sends is variable across the industry. This creates additional challenges for clinic staff to interpret transmissions uniformly. Standard terminology and democratized data will improve clinic efficiency and the quality of patient care.
Establishing a New Remote Monitoring Program: What is the Optimal Staff Ratio for a Successful Device Clinic?
Ferrara, Wang (2019)
May 12, 2024This poster highlights that in a new EP office with a ratio of 257 patients:1 nurse practitioner is feasible. However, utilizing a third party yielded significantly more actionable events and billing revenue opportunities.
Cardiac Implanted Electronic Device Follow-Up Clinic HRS Survey
Ferrick, Banches, Shea, Orenstein (2020)
May 12, 2024This presentation outlines four major themes of dissatisfaction in remote monitoring: staffing ratios, increasing volume of remote follow-ups and device varieties, lack of patient participation and compliance, workflow, and data consolidation to the EMR.
Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation
Seiler, et. al. (2021)
May 12, 2024Managing CIED transmissions is a complex and time-intensive process creating a heavy workload for clinics. Understanding this process and implementing new strategies, including the adoption of remote monitoring solutions, can create efficiencies for clinics.
Remote Monitoring of Implantable Loop Recorders: False-Positive Alert Episode Burden
O’Shea, et. al. (2021)
May 12, 2024Although implantable loop recorders are vital to the diagnosis and management of cardiac arrhythmias they are responsible for the vast majority of remote transmissions, many of which are false alerts. There are opportunities to improve the usability of this data through reprogramming and third-party alert management tools.
Remote Monitoring Alert Burden: An Analysis of Transmissions in >26,000 Patients
O’Shea, et. al. (2021)
May 12, 2024In this study 54.8% of patients transmitted at least 1 alert during a 12-month period, totaling over 82,000 alerts. These alerts had a high proportion of false positives and other transmissions that did not require action. Automated software was identified as a potential solution to relieve some of this burden.
Expert Consensus Statement and Remote Patient Monitoring Guidelines
Kevin Hoffman
May 12, 2024A few of the most important key takeaways from the Heart Rhythm Society’s presentation of the Expert Consensus Statement
Challenges in Managing a Remote Monitoring Device Clinic
Harvey, Seiler (2022)
May 12, 2024Three major themes emerged regarding the biggest challenges in managing patients with remote monitoring: patient connectivity, the volume of transmissions, and staffing. Strategies for success included optimizing alerts, assigning dedicated staff, and partnering with third-party platforms.
Making the Most of Cardiac Device Remote Management
Diamond, Varma, Kramer (2021)
May 12, 2024There are opportunities for clinics to harness the benefits of remote while solving for the challenges that stem from an overwhelming volume of transmissions. The authors propose three areas of improvement: advanced technology with simple dashboards, industry data standardization, and reimbursement policy changes.