Practical Management of the Remote Device Clinic
Introduction
Introduction
Key Points
- Remote monitoring (RM) improves morbidity and mortality in the management of patients with cardiovascular implantable electronic devices (CIEDs).
- The number of CIEDs implanted on an annual basis has grown to approximately 1.7 million worldwide.
- This expert consensus statement provides evidence-based recommendations for all aspects of RM services.
Take-Home Messages
- For patients with CIEDs, RM is the standard of care.
- Prompt patient enrollment and maintenance of regular connectivity with long-term adherence to RM accomplished by individualized patient and caregiver education is essential to an effective RM program.
- Adequate staffing using both clinical and nonclinical personnel with appropriate patient-to-staff ratios and dedicated time to perform defined roles and responsibilities are essential for managing RM clinic workflows.
- Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
- Programming alerts specific to device type and indication with established mechanisms for promptly dealing with high-priority alerts can moderate increasing data volume and workload for RM programs.
- Communicating RM device results with patients, their health care providers, and the patient electronic medical record in a secure and confidential manner should be accomplished according to individual device clinic workflows.
- A relationship between RM clinics and device manufacturers for bidirectional exchange of ideas for staff training, patient education, patient care services, and management of safety advisories and recalls is imperative.
- Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
- Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
- s) require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the ILR.
- Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.
General Concepts
...General Conce...
...1. Definitions Programmer - A manufacture...
...RM consideration...
...ents with CIEDs, RM is recommended as par...
...with CIEDs on RM, routine surveillance...
...ents with CIEDs on RM with a device capable of co...
...RM payment/r...
...e care of patients with CIEDs on RM, it...
Administrative and Nonclinical Staff
...Administrative...
...tients with an ILR, enrollment in an RM prog...
...with a CIED, it can be beneficial...
...Managing and updating...
...of patients with CIEDs on RM who undergo d...
...re of patients with CIEDs on RM who lose...
Staffing of Remote Monitoring Clinics
...Staffing of...
...Staffing require...
...he care of patients with CIEDs on RM, a tea...
For the care of patients with CIEDs on RM,...
...of patients with CIEDs on RM, it is reco...
...care of patients with CIEDs on RM, it is r...
...Staf...
...patients with CIEDs on RM, it is recommended...
...patients with CIEDs on RM, it is recomme...
...fing Challenges With Remote Monitoring...
...HRS Expert Consensus Statement on RM vs 2023...
Technical Considerations in Remote Monitoring
...Technic...
...ple of a Timeline for Patients With CIEDs on...
...Devi...
...nts with CIEDs on RM in the absence of contin...
...n patients with CIEDs on RM in the absence of con...
...Site-based R...
...s with CIEDs in centers without onsite device i...
...atients with CIEDs in centers with ons...
...ional Personal 1:1 vs Site-based RM With tr...
...gure 5. Illustrative Example of Unsched...
Alert-based Remote Monitoring
...Alert-based Remote...
...th CIEDs and a component with a safety advis...
...ients with pacemakers (PMs) on RM wit...
In patients with ICDs on RM with consistent a...
Programming Considerations for Optimal Remote Monitoring
...Programmi...
...patients with CIEDs on RM, it is reco...
...emote Monitoring System Differences Between...
...lert Recommendations by Device Typ...
...P...
...tients with CIEDs on RM, it is recommended that...
...with ICDs on RM, it is recommended that the...
...ts with CIEDs on RM, it is reasonable to remotely...
...h CIEDs on RM with CRT, it is reasonable that th...
...with CIEDs on RM with atrial arrhythmia...
...th ICDs on RM, it is reasonable that the CIED...
...care of patients with CIEDs on RM,...
...Special progr...
...n patients with ILRs on RM, it is re...
...patients with ILRs on RM, it is recom...
In patients with ILRs on RM and frequent...
...with ILRs on RM for unexplained syncope, it i...
...with ILRs on RM for cryptogenic str...
...ith ILRs on RM with consistent connectiv...
Managing Alerts
...Managing Alerts...
...igure 7. Red and Yellow Alerts for...
...Defining...
...patients with CIEDs on RM, it is recommend...
...Pro...
...with CIEDs on RM from whom sufficient clinical...
For the care of patients with CIEDs on RM, it...
...Remote Monitoring Alerts That Should Be Cons...
...Ti...
...e of patients with CIEDs on RM, it is re...
...e 9. Minimizing Alerts for Nonactionable E...