Implementing an alert-based strategy: A path to sustainable remote monitoring of cardiovascular electronic devices

Remote monitoring (RM) has become the standard of care for patients with cardiovascular implantable electronic devices, but its widespread use presents challenges for clinical staff.

We conducted a retrospective observational analysis of RM activity at a single center from 2018 to 2023. The center provides follow-up for pacemaker, implantable cardioverter defibrillator (ICD), and implantable loop recorder (ILR) patients. Interventions included reducing the frequency of scheduled transmissions, reprogramming nonactionable alerts, and transitioning to an alert-based monitoring model. Transmission and visit data were analyzed annually, and estimated staffing needs were calculated using the Heart Rhythm Society's RM Clinic Staffing Calculator.

The number of patients enrolled in RM increased from 1887 in 2018 to 2741 in 2023. During the same period, the number of transmissions per patient-year decreased across all device types (p < 0.05). Staffing estimates based on patient volume suggested a need for up to six full-time staff members. However, actual workload analysis showed that the service was sustained with two full-time equivalents, due to workflow optimization and alert-based RM management.

An alert-based remote monitoring strategy, tailored to patient clinical characteristics and focused on reducing nonactionable alerts, can enhance efficiency and service sustainability. While these results reflect a specific institutional model, they support broader efforts to optimize RM practices in alignment with recent expert consensus guidelines.