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 Con...

...itions Programmer - A manufacturer-specific...


...considerations...

...ients with CIEDs, RM is recommended...

...tients with CIEDs on RM, routine surveil...

...atients with CIEDs on RM with a devi...


...t/reimbursement models...

...f patients with CIEDs on RM, it is recommended th...


Administrative and Nonclinical Staff

...ative and Nonclinical Staff...

...t enrollment techniques

...s with an ILR, enrollment in an RM progr...

...s with a CIED, it can be beneficial to initiat...


...ng and updating manufacturer websites

...re of patients with CIEDs on RM who underg...


...echniques to optimize patient connectivity...

...of patients with CIEDs on RM who lose conn...


Staffing of Remote Monitoring Clinics

Staffing of Remote Monitor...

...requirements for RM...

...re of patients with CIEDs on RM, a te...

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

...he care of patients with CIEDs on RM, it i...

For the care of patients with CIEDs o...


...tialing and qualifications for RM...

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

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


...igure 1. Staffing Challenges With Remote Monit...


.... 2015 HRS Expert Consensus Statement on...


Technical Considerations in Remote Monitoring

...derations in Remote Monitoring...

...ple of a Timeline for Patients With CIEDs o...


...ces with noncontinuou...

...patients with CIEDs on RM in the absence...

...h CIEDs on RM in the absence of continuous connect...


...ite-based R...

...h CIEDs in centers without onsite devi...

...patients with CIEDs in centers with onsite...


...igure 4. Traditional Personal 1:1 vs Si...


...Illustrative Example of Unscheduled CIED...


Alert-based Remote Monitoring

...rt-based Remote Monit...

...ert-based RM

...ith CIEDs and a component with a saf...

...n patients with pacemakers (PMs) on RM with co...

...ICDs on RM with consistent and continuous connect...


Programming Considerations for Optimal Remote Monitoring

...ogramming Considerations for Optimal...

...rer and device-specific knowledge...

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


...Monitoring System Differences Between Manufac...


...Recommendations by Device TypeColors corr...


...clinical indications with different types...

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

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

...ts with CIEDs on RM, it is reasonable...

...h CIEDs on RM with CRT, it is reason...

...ents with CIEDs on RM with atrial arrhyt...

...ts with ICDs on RM, it is reasonable that the CI...

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


...rogramming considerations for ILRs...

...nts with ILRs on RM, it is recommended that clin...

In patients with ILRs on RM, it is re...

...h ILRs on RM and frequent undersensing and/or...

...ients with ILRs on RM for unexplained synco...

...ILRs on RM for cryptogenic stroke, it is rea...

...th ILRs on RM with consistent connectivity, in-of...


Managing Alerts

...aging Alerts...

...Red and Yellow Alerts for PMs and I...


...high-priority alert...

...s with CIEDs on RM, it is recommended th...


...gramming considerations to minimize inappropr...

...CIEDs on RM from whom sufficient clinical da...

...patients with CIEDs on RM, it is reasonable for cl...


...Monitoring Alerts That Should Be C...


...mendations for alert management...

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


Figure 9. Minimizing Alerts for Nonac...