Practical Management of the Remote Device Clinic
Introduction
Introduction
Key Points
- Remote monitoring (RM) improves morbidity and mortality in the management of patients with cardiovascular implantable electronic devices (CIEDs).
- The number of CIEDs implanted on an annual basis has grown to approximately 1.7 million worldwide.
- This expert consensus statement provides evidence-based recommendations for all aspects of RM services.
Take-Home Messages
- For patients with CIEDs, RM is the standard of care.
- Prompt patient enrollment and maintenance of regular connectivity with long-term adherence to RM accomplished by individualized patient and caregiver education is essential to an effective RM program.
- Adequate staffing using both clinical and nonclinical personnel with appropriate patient-to-staff ratios and dedicated time to perform defined roles and responsibilities are essential for managing RM clinic workflows.
- Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
- Programming alerts specific to device type and indication with established mechanisms for promptly dealing with high-priority alerts can moderate increasing data volume and workload for RM programs.
- Communicating RM device results with patients, their health care providers, and the patient electronic medical record in a secure and confidential manner should be accomplished according to individual device clinic workflows.
- A relationship between RM clinics and device manufacturers for bidirectional exchange of ideas for staff training, patient education, patient care services, and management of safety advisories and recalls is imperative.
- Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
- Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
- s) require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the ILR.
- Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.
General Concepts
...eneral Conce...
...le 1. Definitions Programmer - A ma...
...consideration...
...tients with CIEDs, RM is recommended as part of...
...ts with CIEDs on RM, routine surveill...
...s with CIEDs on RM with a device capa...
...ment/reimbursement models...
...e care of patients with CIEDs on RM, it is reco...
Administrative and Nonclinical Staff
...nistrative and Nonclinical Staff...
...enrollment techniques...
In patients with an ILR, enrollment in...
...atients with a CIED, it can be benefic...
...anaging and updating manufacturer w...
...of patients with CIEDs on RM who undergo devic...
...ues to optimize patient connectivity...
...or the care of patients with CIEDs...
Staffing of Remote Monitoring Clinics
...ing of Remote Monitoring Clinics...
...requirements for RM...
...e care of patients with CIEDs on RM, a team-based...
...the care of patients with CIEDs on RM...
...care of patients with CIEDs on RM, it is recomm...
For the care of patients with CIEDs o...
...ling and qualifications for RM
...f patients with CIEDs on RM, it is recomm...
For the care of patients with CIEDs on RM,...
...ng Challenges With Remote Monitoring...
...2015 HRS Expert Consensus Statement on RM...
Technical Considerations in Remote Monitoring
...onsiderations in Remote Monitoring
.... Example of a Timeline for Patients With CIEDs...
...ces with noncontinuous RM...
...n patients with CIEDs on RM in the absence of...
...CIEDs on RM in the absence of continuous...
...ite-based RM...
...with CIEDs in centers without onsite de...
...s with CIEDs in centers with onsite device int...
...4. Traditional Personal 1:1 vs Site-base...
...igure 5. Illustrative Example of Unsched...
Alert-based Remote Monitoring
...ert-based Remote Monitoring...
...ert-based RM...
...ents with CIEDs and a component with a s...
...ients with pacemakers (PMs) on RM with consis...
...with ICDs on RM with consistent and...
Programming Considerations for Optimal Remote Monitoring
...rogramming Considerations for Optimal Remote Monit...
...acturer and device-specific kn...
...patients with CIEDs on RM, it is recom...
...able 2. Remote Monitoring System Diff...
...6. Alert Recommendations by Device TypeCo...
...clinical indications with different types...
...ith CIEDs on RM, it is recommended that ale...
...h ICDs on RM, it is recommended that...
...nts with CIEDs on RM, it is reasonable to remotely...
...tients with CIEDs on RM with CRT, it is reasonable...
...n patients with CIEDs on RM with a...
...ith ICDs on RM, it is reasonable that the...
...of patients with CIEDs on RM, it is reasonable th...
Special programming considerations for ILR...
...h ILRs on RM, it is recommended that clinic s...
...n patients with ILRs on RM, it is reco...
...nts with ILRs on RM and frequent undersensi...
...n patients with ILRs on RM for unexplained syncope...
...with ILRs on RM for cryptogenic st...
...nts with ILRs on RM with consistent con...
Managing Alerts
...aging Alerts...
...re 7. Red and Yellow Alerts for PMs and ICD...
...ining high-priority alert...
...patients with CIEDs on RM, it is recommended that...
...ng considerations to minimize inapp...
...ts with CIEDs on RM from whom sufficient...
...of patients with CIEDs on RM, it is reasonable fo...
.... Remote Monitoring Alerts That Should Be...
...line recommendations for alert man...
...of patients with CIEDs on RM, it...
...zing Alerts for Nonactionable Events...