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Remote Monitoring Alert Burden: An Analysis of Transmission in >26,000 Patients
Catherine J O'Shea1, Melissa E Middeldorp1, Jeroen M Hendriks2
1Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia.
JACC. Clinical Electrophysiology
|February 19, 2021
Summary
Over half of patients with cardiac implantable electronic devices (CIEDs) generated alerts during remote monitoring (RM). Implantable loop recorders (ILRs) contributed significantly to the alert burden, necessitating new management strategies.
Area of Science:
- Cardiology
- Biomedical Engineering
- Health Informatics
Background:
- Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) enables early detection of critical patient and device events.
- Current RM practices often involve manual workflows during business hours, creating a significant alert burden.
- Automated software solutions show promise in reducing manual workload and improving real-time alert response.
Purpose of the Study:
- To assess the alert burden associated with remote monitoring in a large, multicenter cohort of patients with CIEDs.
- To analyze the types, acuity, and sources of alerts generated by different CIED categories.
- To identify potential areas for optimizing RM workflows and alert management.
Main Methods:
- Retrospective analysis of 26,713 patients with CIEDs undergoing managed RM using PaceMate software from November 2018 to November 2019.
- Categorization of alerts by type, acuity (red for urgent, yellow for non-urgent), and CIED type (permanent pacemaker, implantable cardioverter-defibrillator, implantable loop recorder).
Main Results:
- 54.8% of patients (14,638/26,713) generated at least one alert during the 12-month study period, totaling 82,797 alerts from 205,804 transmissions.
- Implantable loop recorders (ILRs) accounted for 50.1% of all alerts, while permanent pacemakers (PPMs) generated 31.0% and implantable cardioverter-defibrillators (ICDs) 18.9%.
- Urgent (red) alerts constituted 4.8% of total alerts, with ICDs responsible for 52.7% of these, often related to ventricular tachyarrhythmias and pacing/shock delivery.
Conclusions:
- A substantial proportion of patients with CIEDs generate alerts during remote monitoring, highlighting a significant alert burden.
- ILRs are disproportionately represented in the alert data, indicating a substantial management challenge.
- The high volume of alerts necessitates the development of novel management pathways for efficient and effective remote monitoring of CIEDs.
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