Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients.
cardiac resynchronization therapy
home monitoring
implantable cardioverter-defibrillator
implantable loop recorder
pacemaker
remote transmissions
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
06
07
2020
revised:
14
08
2020
accepted:
16
08
2020
entrez:
19
2
2021
pubmed:
20
2
2021
medline:
19
8
2021
Statut:
ppublish
Résumé
This study sought to determine the remote monitoring (RM) alert burden in a multicenter cohort of patients with a cardiac implantable electronic device (CIED). RM of CIEDs allows timely recognition of patient and device events requiring intervention. Most RM involves burdensome manual workflow occurring exclusively on weekdays during office hours. Automated software may reduce such a burden, streamlining real-time alert responses. We retrospectively analyzed 26,713 consecutive patients with a CIED undergoing managed RM utilizing PaceMate software between November 2018 and November 2019. Alerts were analyzed according to type, acuity (red indicates urgent, and yellow indicates nonurgent) and CIED category. In total, 12,473 (46.7%) patients had a permanent pacemaker (PPM), 9,208 (34.5%) had an implantable cardioverter-defibrillator (ICD), and 5,032 (18.8%) had an implantable loop recorder (ILR). Overall, 82,797 of the 205,804 RM transmissions were alerts, with the remainder being scheduled transmissions. A total of 14,638 (54.8%) patients transmitted at least 1 alert. Permanent pacemakers were responsible for 25,700 (31.0%) alerts, ICDs for 15,643 (18.9%) alerts, and ILRs for 41,454 (50.1%) alerts, with 3,935 (4.8%) red alerts and 78,862 (95.2%) yellow alerts. ICDs transmitted 2,073 (52.7%) red alerts; 5,024 (32.1%) ICD alerts were for ventricular tachyarrhythmias and antitachycardia pacing/shock delivery. In an RM cohort of 26,713 patients with CIEDs, 54.8% of patients transmitted at least 1 alert during a 12-month period, totaling over 82,000 alerts. ILRs were overrepresented, and ICDs were underrepresented, in these alerts. The enormity of the number of transmissions and the growing ILR alert burden highlight the need for new management pathways for RM.
Sections du résumé
OBJECTIVES
This study sought to determine the remote monitoring (RM) alert burden in a multicenter cohort of patients with a cardiac implantable electronic device (CIED).
BACKGROUND
RM of CIEDs allows timely recognition of patient and device events requiring intervention. Most RM involves burdensome manual workflow occurring exclusively on weekdays during office hours. Automated software may reduce such a burden, streamlining real-time alert responses.
METHODS
We retrospectively analyzed 26,713 consecutive patients with a CIED undergoing managed RM utilizing PaceMate software between November 2018 and November 2019. Alerts were analyzed according to type, acuity (red indicates urgent, and yellow indicates nonurgent) and CIED category.
RESULTS
In total, 12,473 (46.7%) patients had a permanent pacemaker (PPM), 9,208 (34.5%) had an implantable cardioverter-defibrillator (ICD), and 5,032 (18.8%) had an implantable loop recorder (ILR). Overall, 82,797 of the 205,804 RM transmissions were alerts, with the remainder being scheduled transmissions. A total of 14,638 (54.8%) patients transmitted at least 1 alert. Permanent pacemakers were responsible for 25,700 (31.0%) alerts, ICDs for 15,643 (18.9%) alerts, and ILRs for 41,454 (50.1%) alerts, with 3,935 (4.8%) red alerts and 78,862 (95.2%) yellow alerts. ICDs transmitted 2,073 (52.7%) red alerts; 5,024 (32.1%) ICD alerts were for ventricular tachyarrhythmias and antitachycardia pacing/shock delivery.
CONCLUSIONS
In an RM cohort of 26,713 patients with CIEDs, 54.8% of patients transmitted at least 1 alert during a 12-month period, totaling over 82,000 alerts. ILRs were overrepresented, and ICDs were underrepresented, in these alerts. The enormity of the number of transmissions and the growing ILR alert burden highlight the need for new management pathways for RM.
Identifiants
pubmed: 33602404
pii: S2405-500X(20)30815-X
doi: 10.1016/j.jacep.2020.08.029
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
226-234Commentaires et corrections
Type : CommentIn
Informations de copyright
Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Supported by Postgraduate Scholarships (to Drs. O’Shea, Emami, Mishima, and Thiyagarajah), a Postdoctoral Fellowship (to Dr. Middeldorp), and the Robert J. Craig Lectureship (to Dr. Lau) from the University of Adelaide; Fellowships from The Hospital Research Fund (to Drs. Lau and Hendriks); and Practitioner Fellowships from the National Health and Medical Research Council of Australia (to Dr. Sanders) and the National Heart Foundation of Australia (to Dr. Sanders). Dr. Brooks is currently employed by Microport. Dr. Lau reports that the University of Adelaide receives on his behalf lecture and/or consulting fees from Biotronik, Bayer, Medtronic, Abbott Medical, Boehringer Ingelheim, MicroPort, and Pfizer. Dr. Fiegofsky has served on the Advisory Board of PaceMate. Dr. Gopinathannair has received consulting fees or honoraria from Abbott Medical, Boston Scientific, Pfizer, Zoll Medical; and has served on the advisory board of HealthTrust PG, Pacemate, and Altathera. Dr. Varma has consulted for Medtronic, Abbott Medical, Boston Scientific, Biotronik, and Microport; and has served on the advisory board for PaceMate. Dr. Campbell is currently employed by PaceMate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.