Assessing adherence to remote monitoring recommendations for cardiovascular implantable electronic devices: a retrospective analysis

Abstract Background The recently published Expert Consensus Statement on the Practical Management of Remote Device Clinic offers evidence-based recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). Purpose This study evaluates adherence to remote monitoring (RM) recommendations in current clinical practice using data from a RM database. Methods According to RM guidelines, patient connectivity should be maintained. If continuous connection is ensured, it is reasonable to schedule in-person visits every 24 months, with alert-based RM potentially replacing structured intermittent device follow-up. Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 Italian centers between 2010 and 2023 were analyzed. Median RM duration was 40 months (25th-75th percentile: 23-67). Results Enrollment of patients at centers significantly increased over the observation period (Figure). As of the January 2024 data extraction, 4723 patients had transmitted data in the last 12 months. Among these, 639 (14%) were NOT MONITORED (i.e. interrupted connectivity), with no significant differences among CIED types (Pacemaker: 13%; ICD: 12%; CRT-P: 7%; CRT-D: 13%; S-ICD: 18%). Scheduled device transmissions occurred at least once every 3 months in 96% of patients. The volume of in-office device interrogations and remote transmissions is detailed in Figure. In 2023, among the 4084 MONITORED patients, 6600 in-office device interrogations were conducted, and 64296 remote transmissions were reviewed. Of these, 34267 (53%) were scheduled, 15091 (24%) were patient-initiated, and only 14938 (23%) were triggered by alerts. Conclusions In current clinical practice, RM adoption is increasing, alongside the volume of in-office and remote visits. Solutions must be implemented to ensure transmission continuity in a substantial percentage of patients. Additionally, there persists a significant reliance on frequent scheduled transmissions and in-office visits. Centers stand to gain from implementing the guideline-recommended alert-based RM strategy, reducing the considerable burden of nonactionable remote and in-office visits among patients with continuous connectivity.