Implementation of remote follow-up of cardiac implantable electronic devices in clinical practice: organizational implications and resource consumption

Abstract

Aims Current guidelines recommend remote follow-up for all patients with cardiac implantable electronic devices. However, the introduction of a remote follow-up service requires specifically dedicated organization. We evaluated the impact of adopting remote follow-up on the organization of a clinic and we measured healthcare resource utilization. Methods In 2016, we started the implementation of the remote follow-up service. Each patient was assigned to an experienced nurse and a doctor in charge with preestablished tasks and responsibilities. During 2016 and 2017, all patients on active follow-up at our center were included in the service; since 2018, the service has been fully operational for all patients following postimplantation hospital discharge. Results As of December 2018, 2024 patients were on active follow-up at the center. Of these, 93% of patients were remotely monitored according to the established protocol. The transmission rates were: 5.3/patient-year for pacemakers, 6.0/patient-year for defibrillators, and 14.1/patient-year for loop recorders. Only 21% of transmissions were submitted to the physician for further clinical evaluation, and 3% of transmissions necessitated an unplanned in-hospital visit for further assessment. Clinical events of any type were detected in 39% of transmissions. Overall, the nurses’ total workload was 3596 h per year, that is, 1.95 full-time equivalent, which resulted in 1038 patients/nurse. The total workload for physicians was 526 h per year, that is, 0.29 full-time equivalent. After 1 year on follow-up, most patients judged the service positively and expressed their preference for the new follow-up approach. Conclusion A remote follow-up service can be implemented and efficiently managed by nursing staff with minimal physician support. Patients are followed up with greater continuity and seem to appreciate the service.

Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

“…It would be desirable to have a greater degree of computerisation in the future with the possibility that the reports are inserted in a patient file, visible to all the figures involved in the patient management. This already happens in some regions with positive results [13].…”

“…In the majority of the participating centres, the transmissions are submitted to the referring physician in charge of the service only in case of critical events. In a previous work, Maines et al [13] described the implementation of the organizational model proposed by AIAC, and measured the healthcare resources needed for its management; in that study, 39% of transmissions had events and only 20% required medical supervision. It would also be important to reduce unnecessary transmissions and optimise device programming so as to avoid redundant transmissions or alarms [14].…”

Short-term outcome associated with remote evaluation (telecardiology) of patients with cardiovascular diseases during the COVID-19 pandemic

“…Patients scheduled for non-invasive cardiac exams were also contacted to determine appropriateness and urgency. Ninety-six % of patients with cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators and loop recorders remote were already followed-up by telecardiology with home monitoring devices thanks to a program that started in 2016 [2] ( Fig. 1 ).…”

Remote monitoring and telemedicine in heart failure: implementation and benefits

“…However, RM is still largely underused in clinical practice [92]. Barriers to its implementation are mainly the lack of reimbursement, need for significant changes in hospitals' workflows, data overload, and increased workload for health-care providers [97][98][99][100][101]. The growing bunch of clinical evidence on the safety and usefulness of RM, combined with the overcoming of the reimbursement issue, will probably lead to a wider overall adoption of this valuable tool, which will obviously will markedly benefit from active involvement of general practitioners, caregivers, and empowered patients [102].…”