Bridging the Gap: Remote Evaluation and Programming of Cardiac Implantable Devices in Medically Underserved Areas

Delivering care in medically underserved areas (MUA) is a public health challenge.

The purpose of this study was to evaluate the advantages of a noncommercial multivendor solution for remote interrogation and programming of cardiac implantable electronic devices (CIEDs) among inhabitants of MUAs.

This prospective comparative study evaluated benefits and safety of remote CIEDs evaluation in patients living >100 km from the Bordeaux University Hospital. A conventional in-person evaluation at the Bordeaux hospital was compared with a remote evaluation performed 6 months later at a nurse office close to the patient home. The technical solution consisted of remote controlling CIED programmers from the 5 main manufacturers allowing evaluation of all kinds of CIEDs.

A majority of the 34 included patients (94%) were satisfied with the remote evaluation strategy. To attend the in-person evaluation at the Bordeaux Hospital, the patients covered a median distance of 253 km (ICR: 221-258 km) compared with 9 km (ICR: 6-19 km) (P < 0.001) to get to the nurse's office. The use of a medical vehicle was reduced by a factor 7 (44% vs 6%; P = 0.001) with the remote evaluation, which translated into a reduction in the total traveling cost per patient by a factor 32 (96 Euros [87-268 Euros] vs 3 Euros [2-8 Euros]; P < 0.001). The travel carbon footprint was 14 times lower (28 Kg CO₂-eq [24-28 Kg CO₂-eq] vs 2 Kg CO₂-eq [1-5 Kg CO₂-eq]; P < 0.001) with the remote evaluation strategy.

Remote evaluation of CIEDS in patients living MUA is feasible and safe. This approach is associated with a high level of satisfaction, lower economic and ecological costs compared with the in-person assessment in this population. (Remote Programming of Cardiac Implantable Electronic Devices 2 [REACT 2]; NCT06272344).