Abstract 4139909: Rural and Urban Patterns of Monitoring of Implanted Cardiac Devices in the US

Background: Along with in-person (IP) monitoring, remote monitoring (RM) is recommended for patients with a cardiac implantable electronic device (CIED) to improve clinical outcomes. Hypothesis: Rurality will adversely impact the delivery of both RM and IP monitoring as part of comprehensive CIED care. Aims: To define and compare CIED monitoring patterns among patients with a CIED in rural and urban geographies. Methods: All Medicare fee-for-service beneficiaries (2011-2021) with history of CIED implantation were included based on relevant CPT codes. Demographic characteristics were reported by implant year and stratified by rurality based on beneficiary rural-urban commuting area code. All IP and RM events in the year following implant were tabulated based on CPT and ICD-9/10 procedure codes and similarly stratified by geography. Results: Approximately 23% of the de novo CIED implants (approximately 150,000/year) were among patients living in rural areas. The mean age was 79-80 years across the study period and was slightly higher (<1 yr difference) in the urban group; the proportion of men was similar in each group (~57%). Comorbidity was high in both geographic strata throughout the study period, including hypertension (~94%), ischemic heart disease (~80%) and heart failure (~65%). In the year following implant, the proportion of patients with ≥1 IP monitoring event was stable and consistently greater among the urban than rural cohort (~81% vs ~78% in 2019) until 2020 when the proportion fell for both groups (75% vs 72%, respectively) (Figure). The proportion of patients with ≥1 RM event rose substantially over the study period (from 22% to 51% in the urban group and 28% to 50% in the rural group). Conclusions: Dramatic improvements in RM were observed among Medicare beneficiaries with a CIED in the last decade. Patients in rural areas were historically more likely to undergo RM than their urban counterparts, but this gap narrowed and equalized over time. By 2020, a decline in IP monitoring was accompanied by an increase of growth in RM in both urban and rural areas, possibly reflecting effects of the COVID pandemic on CIED care access.