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. 2023 May 6;4(6):374-381.
doi: 10.1016/j.hroo.2023.04.005. eCollection 2023 Jun.

Data deluge from remote monitoring of cardiac implantable electronic devices and importance of clinical stratification

Danish Bawa  1 , Rajesh Kabra  1 , Adnan Ahmed  1 , Shanti Bansal  2 , Douglas Darden  1 , Naga Venkata K Pothineni  1 , Rakesh Gopinathannair  1 , Dhanunjaya Lakkireddy  1
Affiliations

Data deluge from remote monitoring of cardiac implantable electronic devices and importance of clinical stratification

Danish Bawa et al. Heart Rhythm O2. .

Abstract

Background: Remote monitoring (RM) has been accepted as a standard of care for follow-up of patients with cardiac implantable electronic devices (CIEDs). However, the resulting data deluge poses major challenge to device clinics.

Objective: This study aimed to quantify the data deluge from CIED and stratify these data based on clinical relevance.

Methods: The study included patients from 67 device clinics across the United States being remotely monitored by Octagos Health. The CIEDs included implantable loop recorders, pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy defibrillators, and cardiac resynchronization therapy pacemakers. Transmissions were either dismissed before reaching the clinical practice if they were repetitive or redundant or were forwarded if they were either clinically relevant or actionable transmission (alert). The alerts were further classified as level 1, 2, or 3 based on clinical urgency.

Results: A total of 32,721 patients with CIEDs were included. There were 14,465 (44.2%) patients with pacemakers, 8381 (25.6%) with implantable loop recorders, 5351 (16.4%) with implantable cardioverter-defibrillators, 3531 (10.8%) with cardiac resynchronization therapy defibrillators, and 993 (3%) with cardiac resynchronization therapy pacemakers. Over a period of 2 years of RM, 384,796 transmissions were received. Of these, 220,049 (57%) transmissions were dismissed, as they were either redundant or repetitive. Only 164,747 (43%) transmissions were transmitted to the clinicians, of which only 13% (n = 50,440) had clinical alerts, while 30.6% (n = 114,307) were routine transmissions.

Conclusion: Our study shows that data deluge from RM of CIEDs can be streamlined by utilization of appropriate screening strategies that will enhance efficiency of device clinics and provide better patient care.

Keywords: Alerts; Cardiac implantable electronic device; Data deluge; Efficiency; Remote monitoring; Remote transmissions.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Distribution by device type. CRT-D = cardiac resynchronization therapy defibrillator; CRT-P = cardiac resynchronization therapy pacemaker; ICD = implantable cardioverter-defibrillator; ILR = implantable loop recorder.
Figure 2
Figure 2
A: Total transmissions from all devices. B: Transmissions from Loop Recorders. C: Transmissions from implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillator. D: Transmissions from pacemaker and cardiac resynchronization therapy pacemakers.
Figure 3
Figure 3
A: Distribution of level 1 alerts by type and device. B: Distribution of level 2 alerts by type and device. C: Distribution of level 3 alerts by type and device. AF = atrial fibrillation; AFL = atrial flutter; ATP = antitachycardia pacing; BiV = biventricular; CRT-D = cardiac resynchronization therapy defibrillator; CRT-P = cardiac resynchronization therapy pacemaker; EOS = end of service; ERI = elective replacement indication; HF = heart failure; ICD = implantable cardioverter-defibrillator; OAC = oral anticoagulation.
See this image and copyright information in PMC

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