2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic
Learn about the new recommendations on Practical Management of the Remote Device Clinic.
Aileen M. Ferrick, PhD, ACNP, RN, FHRS (Co-Chair), Satish R. Raj, MD, MSCI, FHRS (Co-Chair), Thomas Deneke, MD, PhD, FHRS (EHRA Vice-Chair), Pipin Kojodjojo, MBBS, PhD, FHRS (APHRS Vice-Chair), Nestor Lopez-Cabanillas, MD (LAHRS Vice-Chair), Haruhiko Abe, MD, PhD, Serge Boveda, MD, PhD, FEHRA, FESC, Derek S. Chew, MD, MSc, FHRS, Jong-Il Choi, MD, PhD, MHS, Nikolaos Dagres, MD, Aarti S. Dalal, DO, FACC, FHRS, CEPS-P, Brynn E. Dechert, APN, FHRS, CCDS, Camille G. Frazier-Mills, MD, MHS, CCDS, Olivia Gilbert, MD, MSc, FACC, Janet K. Han, MD, FACC, FHRS, Sherri Hewit, PharmD, Christine Kneeland, BSN, Starr DeEllen Mirza, Suneet Mittal, MD, FHRS, Renato Pietro Ricci, MD, Mary Runte, PhD, Susan Sinclair, NZCS, PGDHSc,
Ricardo Alkmim-Teixeira, MD, PhD, Bert Vandenberk, MD, PhD, Niraj Varma, MA, MD, PhD
Highlights from the 2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic
An underlying impediment to worldwide adoption of RM is the irregular availability of reimbursement. This international consensus document delivers a strong message to health care payors to provide adequate reimbursement, according to the country or regional health system, for costs of the RM system itself (hardware, software, and industry service); physician interpretation and effort of allied health professionals; and administrative and nonclinical personnel.
Varma N. Highlights from the 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic. Heart Rhythm O2. 2023 Aug 28;4(9):526-527. doi: 10.1016/j.hroo.2023.08.001. PMID: 37744939; PMCID: PMC10513915.
A 2023 study led by Professor Niraj Varma explores the evolution of remote monitoring in managing Cardiac Implantable Electronic Devices (CIEDs). The findings highlight a shift from periodic in-office appointments to continuous, personalized remote monitoring, suggesting more efficient and patient-specific care. This change could extend in-office visits to every 24 months for stable patients, impacting healthcare workflow, reimbursement, and data management.
Varma N, Braunschweig F, Burri H, Hindricks G, Linz D, Michowitz Y, Ricci RP, Nielsen JC. Remote monitoring of cardiac implantable electronic devices and disease management. Europace. 2023 Aug 2;25(9):euad233. doi: 10.1093/europace/euad233. PMID: 37622591; PMCID: PMC10451003.
Alert-driven vs. Scheduled Remote Monitoring of Implantable Cardiac Defibrillators: A Cost-Consequence Analysis from the TRUST Trial
Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters.
Chew DS, Piccini JP, Au F, et al. Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial. Heart Rhythm. 2023;20(3):440-447. doi:10.1016/j.hrthm.2022.12.003
Clinician Use of Data Elements from Cardiovascular Implantable Electronic Devices in Clinical Practice
The present study investigated clinicians’ frequency of use of CIED data in clinical practice and revealed preferences and challenges with using CIED reports in clinical decision-making. The survey findings suggest that CIED data reports are comprehensive, providing an abundance of important information. However, improvements can be made to organize reports better to enhance the use of actionable data in clinical practice.
Daley C, Coupe A, Allmandinger T, Shirazi J, Wagner S, Drouin M, Ahmed R, Toscos T, Mirro M. Clinician use of data elements from cardiovascular implantable electronic devices in clinical practice. Cardiovasc Digit Health J. 2023 Jan 20;4(1):29-38. doi: 10.1016/j.cvdhj.2022.10.007. PMID: 36865585; PMCID: PMC9972003.
Remote Monitoring of CIEDs—For Both Safety, Economy, and Convenience?
The review summarizes some of the recent research in the field of remote monitoring of cardiac devices. Specifically highlighting major follow-up improvements regarding safety, economic, and patient satisfaction.
Lappegård KT, Moe F. Remote Monitoring of CIEDs-For Both Safety, Economy and Convenience? Int J Environ Res Public Health. 2021 Dec 28;19(1):312. doi: 10.3390/ijerph19010312. PMID: 35010572; PMCID: PMC8751026.
Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients
This study sought to determine the remote monitoring (RM) alert burden in a multicenter cohort of patients with a cardiac implantable electronic device (CIED).
O’Shea CJ, Middeldorp ME, Hendriks JM, et al. Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients. JACC Clin Electrophysiol. 2021;7(2):226-234. doi:10.1016/j.jacep.2020.08.029
HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide Practice Update for Telehealth and Arrhythmia Monitoring During and After a Pandemic
The Covid-19 crisis has accelerated the use of remote patient management in various medical fields, especially among professionals dealing with heart rhythm issues. Catalyzed by the pandemic, the practice of cardiac remote monitoring is here to stay.
Varma N, Marrouche NF, Aguinaga L, et al. HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide Practice Update for Telehealth and Arrhythmia Monitoring During and After a Pandemic. J Am Coll Cardiol. 2020;76(11):1363-1374. doi:10.1016/j.jacc.2020.06.019
Improved Survival in Patients Enrolled Promptly into Remote Monitoring Following Cardiac Implantable Electronic Device Implantation
The retrospective, national, observational cohort study highlights that initiating remote monitoring within 90 days of CIED implantation, compared to delayed initiation, was associated with a lower patient mortality rate. This advantage was observed across all CIED device types.
Mittal S, Piccini JP, Snell J, Prillinger JB, Dalal N, Varma N. Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation. J Interv Card Electrophysiol. 2016 Aug;46(2):129-36. doi: 10.1007/s10840-016-0112-y. Epub 2016 Feb 10. PMID: 26860839; PMCID: PMC4923102.
Remote Monitoring of Cardiac Implantable Electronic Devices (CIED)
Zeitler EP, Piccini JP. Remote monitoring of cardiac implantable electronic devices (CIED). Trends Cardiovasc Med. 2016 Aug;26(6):568-77. doi: 10.1016/j.tcm.2016.03.012. Epub 2016 Mar 31. PMID: 27134007; PMCID: PMC4958580.
Use of Remote Monitoring is Associated with Lower Risk of Adverse Outcomes Among Patients with Implanted Cardiac Defibrillators
The study was conducted to examine the association between the use of remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICD) and all-cause mortality and rehospitalization among patients undergoing initial ICD implant. Upon completion, it was determined that using RPM on patients undergoing first-time ICD implantation is at risk of significantly lower risk of adverse outcomes.
Akar JG, Bao H, Jones PW, Wang Y, Varosy PD, Masoudi FA, Stein KM, Saxon LA, Normand SL, Curtis JP. Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators. Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1173-80. doi: 10.1161/CIRCEP.114.003030. Epub 2015 Jun 19. PMID: 26092577.
2015 HRS Expert Consensus Statement on Remote Interrogation and Monitoring for Cardiovascular Implantable Electronic Devices
Slotwiner D, Varma N, Akar JG, Annas G, Beardsall M, Fogel RI, Galizio NO, Glotzer TV, Leahy RA, Love CJ, McLean RC, Mittal S, Morichelli L, Patton KK, Raitt MH, Ricci RP, Rickard J, Schoenfeld MH, Serwer GA, Shea J, Varosy P, Verma A, Yu CM. HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm. 2015 Jul;12(7):e69-100. doi: 10.1016/j.hrthm.2015.05.008. Epub 2015 May 14. PMID: 25981148.
Rationale and design of the MONITOR-ICD study: A randomized comparison of economic and clinical effects of automatic remote MONITORing versus control in patients with Implantable Cardioverter Defibrillators
Zabel M, Müller-Riemenschneider F, Geller JC, Brachmann J, Kühlkamp V, Dissmann R, Reinhold T, Roll S, Lüthje L, Bode F, Eckardt L, Willich SN; MONITOR-ICD investigators. Rationale and design of the MONITOR-ICD study: a randomized comparison of economic and clinical effects of automatic remote MONITORing versus control in patients with Implantable Cardioverter Defibrillators. Am Heart J. 2014 Oct;168(4):430-7. doi: 10.1016/j.ahj.2014.04.021. Epub 2014 Jun 13. PMID: 25262251.
Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Use of Remote Monitoring for Cardiovascular Implantable Electronic Device Follow-up
Yee R, Verma A, Beardsall M, Fraser J, Philippon F, Exner DV. Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position statement on the use of remote monitoring for cardiovascular implantable electronic device follow-up. Can J Cardiol. 2013 Jun;29(6):644-51. doi: 10.1016/j.cjca.2012.11.036. Epub 2013 Mar 5. PMID: 23465345.
Remote Monitoring of Cardiovascular Devices: A Time and Activity Analysis
Clinical Benefits of Remote Versus Transtelephonic Monitoring of Implanted Pacemakers
This study aimed to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation.