Practical Management of the Remote Device Clinic

Publication Date: May 19, 2023

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

  1. For patients with CIEDs, RM is the standard of care.
  2. 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.
  3. 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.
  4. Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
  5. 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.
  6. 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.
  7. 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.
  8. Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
  9. Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
  10. s) require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the ILR.
  11. Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.

General Concepts

...General Conce...

.... Definitions Programmer - A manu...


...RM considerations...

...CIEDs, RM is recommended as part...

...ith CIEDs on RM, routine surveilla...

...patients with CIEDs on RM with a device capabl...


...RM payment/re...

For the care of patients with CIEDs on RM,...


Administrative and Nonclinical Staff

...Administra...

...Patient en...

...with an ILR, enrollment in an RM program i...

...a CIED, it can be beneficial to initiate RM...


...Managi...

...patients with CIEDs on RM who undergo devic...


...Techniques to optimiz...

...e of patients with CIEDs on RM who lose conne...


Staffing of Remote Monitoring Clinics

...Staffing of...

...Staffing requiremen...

...e of patients with CIEDs on RM, a tea...

...of patients with CIEDs on RM, it is...

...r the care of patients with CIEDs on RM, it is...

...care of patients with CIEDs on RM,...


Staf...

...care of patients with CIEDs on RM, it is re...

...patients with CIEDs on RM, it is recommended t...


...gure 1. Staffing Challenges With Remot...


...HRS Expert Consensus Statement on RM...


Technical Considerations in Remote Monitoring

...Te...

...igure 3. Example of a Timeline for Patien...


...Devices with non...

...s with CIEDs on RM in the absence of continuou...

...atients with CIEDs on RM in the ab...


...Site-based RM...

...s with CIEDs in centers without onsite dev...

...with CIEDs in centers with onsite device...


...Traditional Personal 1:1 vs Site-based RM...


...ustrative Example of Unscheduled CIED Int...


Alert-based Remote Monitoring

...Alert-bas...

...Alert-based RM...

...patients with CIEDs and a componen...

...h pacemakers (PMs) on RM with consistent an...

...patients with ICDs on RM with consisten...


Programming Considerations for Optimal Remote Monitoring

...Programming Co...

...Manufacturer...

...care of patients with CIEDs on RM,...


...ote Monitoring System Differences B...


...igure 6. Alert Recommendations by Devi...


...Programming for clinic...

...ith CIEDs on RM, it is recommended that...

...ith ICDs on RM, it is recommended that the ICD be...

...h CIEDs on RM, it is reasonable to remo...

...s with CIEDs on RM with CRT, it is reasonable...

...ents with CIEDs on RM with atrial arrhythmi...

...tients with ICDs on RM, it is reasonable...

...re of patients with CIEDs on RM, it is reasona...


...Spe...

...h ILRs on RM, it is recommended that cli...

...ith ILRs on RM, it is recommended t...

...patients with ILRs on RM and frequ...

...with ILRs on RM for unexplained syncope...

...nts with ILRs on RM for cryptogeni...

...s with ILRs on RM with consistent connec...


Managing Alerts

...Managing...

...re 7. Red and Yellow Alerts for PMs an...


...Defining hig...

...with CIEDs on RM, it is recommended that for...


...Programming conside...

...h CIEDs on RM from whom sufficient clinic...

...are of patients with CIEDs on RM, it is reasonable...


...igure 8. Remote Monitoring Alerts That...


...or the care of patients with CIEDs on RM, it i...


...izing Alerts for Nonactionable Event...