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Multicenter Study
. 2021 Feb;7(2):226-234.
doi: 10.1016/j.jacep.2020.08.029. Epub 2020 Nov 25.

Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients

Catherine J O'Shea  1 , Melissa E Middeldorp  1 , Jeroen M Hendriks  2 , Anthony G Brooks  3 , Dennis H Lau  1 , Mehrdad Emami  1 , Ricardo Mishima  1 , Anand Thiyagarajah  1 , Suzanne Feigofsky  4 , Rakesh Gopinathannair  5 , Niraj Varma  6 , Kevin Campbell  7 , Prashanthan Sanders  8
Affiliations
Free article
Multicenter Study

Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients

Catherine J O'Shea et al. JACC Clin Electrophysiol. 2021 Feb.
Free article

Abstract

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.

Keywords: cardiac resynchronization therapy; home monitoring; implantable cardioverter-defibrillator; implantable loop recorder; pacemaker; remote transmissions.

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Conflict of interest statement

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.

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