Remote monitoring of cardiovascular devices: a time and activity analysis

BACKGROUND Expanding indications for cardiovascular implantable electronic devices are accompanied by an increasing burden of device clinic follow-up. Remote monitoring (RM) may be less time-consuming compared to in-office follow-up; however, its effect on the device clinic workflow has not been clarified. OBJECTIVE To determine the impact of RM on device clinic workflow. METHODS Detailed workflow data were prospectively collected over a 2-week period in a busy device clinic. RESULTS Five hundred remote transmissions were received from 434 patients between March 1 and March 16, 2011-346 implantable cardioverter-defibrillator, 84 pacemaker, and 70 implantable loop recorder transmissions-on 4 RM platforms (CareLink 56.4%, Merlin. net 21.4%, LATITUDE 17.8%, and Home Monitoring 4.4%). The mean time spent per transmission was 11.5 +/- 7.7 minutes, which was less than in-person interrogations (27.7 +/- 9.9 minutes; P < .01). Of 500 transmissions, 135 (27.0%) demonstrated clinically important findings; however, only 41 (8.2%) were forwarded for physician review. Of 500 transmissions, 138 (27.6%) were unscheduled, and these were more likely to contain a clinically important event (56 of 138 [40.6%] vs 79 of 362 [21.8%]; P = .0001). A total of 5.8% of the transmissions were duplicate. Transmissions that revealed clinically important findings took longer to process than those that did not (21.0 +/- 7.4 minutes vs 10.1 +/- 2.1 minutes; P < .05). A total of 49.2% of the scheduled remote transmissions were missed because of patient noncompliance. Telephone follow-up of patients (mean 21 patients/d) who missed scheduled remote transmissions took a mean of 55.1 (range 20-98) min/d. CONCLUSIONS Analysis of RM transmissions has significant implications for the device clinic workflow. Nonactionable transmissions are rapidly processed, allowing clinicians to focus on clinically important findings. However, poor patient compliance complicates the workflow efficiency of currently available systems.