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
...eral Concepts...
...le 1. Definitions Programmer - A manufacturer-s...
RM considerat...
...ith CIEDs, RM is recommended as part of...
...nts with CIEDs on RM, routine surveill...
...h CIEDs on RM with a device capable of...
...nt/reimbursement models...
...r the care of patients with CIEDs on RM, it is r...
Administrative and Nonclinical Staff
...inistrative and Nonclinical Staf...
...enrollment techniques...
...an ILR, enrollment in an RM program is rec...
In patients with a CIED, it can be beneficial t...
...d updating manufacturer websites...
...patients with CIEDs on RM who unde...
...o optimize patient connectivity...
...patients with CIEDs on RM who lose connectivity,...
Staffing of Remote Monitoring Clinics
...Remote Monitoring Clinics...
...requirements for RM...
...f patients with CIEDs on RM, a team-based orga...
...of patients with CIEDs on RM, it is recommended...
...re of patients with CIEDs on RM, it is recom...
...are of patients with CIEDs on RM, it is reas...
...aff credentialing and qualifications...
...patients with CIEDs on RM, it is recomme...
...care of patients with CIEDs on RM, it is recommen...
...taffing Challenges With Remote Monitoring...
...HRS Expert Consensus Statement on RM...
Technical Considerations in Remote Monitoring
...nical Considerations in Remote...
...le of a Timeline for Patients With CIED...
...ces with noncontinuous RM
...tients with CIEDs on RM in the absence of...
...with CIEDs on RM in the absence of con...
...ite-based...
...ith CIEDs in centers without onsite device int...
...patients with CIEDs in centers with onsite dev...
...ional Personal 1:1 vs Site-based RM Wi...
...5. Illustrative Example of Unscheduled CIED...
Alert-based Remote Monitoring
...ed Remote Monitoring...
...t-based RM
...th CIEDs and a component with a safety advisory,...
...with pacemakers (PMs) on RM with con...
...ICDs on RM with consistent and continuous conn...
Programming Considerations for Optimal Remote Monitoring
...iderations for Optimal Remote Monitoring...
Manufacturer and device-specific kno...
...e care of patients with CIEDs on RM, it is r...
...Remote Monitoring System Differences B...
...re 6. Alert Recommendations by Device...
...g for clinical indications with diff...
...th CIEDs on RM, it is recommended that alert...
...ICDs on RM, it is recommended that the ICD be...
...atients with CIEDs on RM, it is reasonable to remo...
...patients with CIEDs on RM with CR...
...th CIEDs on RM with atrial arrhythmia monito...
In patients with ICDs on RM, it is reasonab...
...the care of patients with CIEDs on RM, it...
...ecial programming considerations for...
...patients with ILRs on RM, it is re...
...with ILRs on RM, it is recommended that...
In patients with ILRs on RM and frequent und...
...tients with ILRs on RM for unexplained syncope, i...
...s with ILRs on RM for cryptogenic stroke, it is re...
...with ILRs on RM with consistent connectivity, in-...
Managing Alerts
...naging Alerts
...ure 7. Red and Yellow Alerts for PMs and I...
...ng high-priority alert...
...ith CIEDs on RM, it is recommended that...
...gramming considerations to minimize inappropriat...
...th CIEDs on RM from whom sufficient...
...of patients with CIEDs on RM, it is reasonabl...
...e Monitoring Alerts That Should Be Considered “H...
...endations for alert management...
...r the care of patients with CIEDs on RM, it i...
...inimizing Alerts for Nonactionable E...