Switching to a 100% remote follow‐up of implantable cardiac electronic devices: Organizational model and results of a single center experience

Introduction During the SARS‐CoV‐2 COVID‐19 pandemic, the global health system needed to review important processes involved in daily routines such as outpatient activities within the hospital, including follow‐up visits of implantable cardiac electronic devices (CIEDs) carried out in office. The aim of this study is to describe our 3.5 years of real‐world experience of a full remote CIED follow‐up, evaluate the success rate of remote transmissions, and verify the adopted organizational model. Methods From April 2020 to November 2023, all patients with an activated and well‐functioning remote monitoring (RM) system and automatic algorithms, like autocapture and autosensing, underwent exclusive RM follow‐up. Unscheduled in‐office visits were only prompted by remote yellow or red alerts. Patients were divided into two groups, based on available technology: Manual Transmission System (MTS) and Automatic Transmission System (ATS). The ATS group, in addition to ensuring a daily transmission of any yellow or red alerts, was checked at least every 15 days to ensure a valid connection. An automatic transmission was scheduled once a year, irrespective of alerts occurred. The MTS group provided a manual transmission every 6 months. Results One thousand nine hundred thirty‐seven consecutive patients were included in the study. By the end of November 2023, a total of 1409 patients (1192 in the ATS and 217 in the MTS group) were still actively followed by our remote clinic (384 expired, 137 dismissed, 7 transferred). The overall success rate of transmissions with the adopted organizational model was 96.6% in the ATS group (connection index) and 87% in the MTS group. Conventional in‐hospital follow‐up visits decreased by 44%. Total clinic working time, resulting from the sum of the time spent during in‐hospital and remote follow‐up, after an initial increase, was progressively reduced to the actual −25%. Mortality rate for any cause was 7.5% per year in remote follow‐up patients and 8.3% (p=NS) in in‐office patients. In the ATS group, no device malfunctions were notified to our remote clinic, before we had already realized it through appropriate alerts. Conclusions The available technology makes moving to a 100% remote clinic possible, without overwhelming clinic workflow, safely. Adopting an appropriate organizational model, it is possible to maintain high transmission success rates. The automatic transmissions allow a more frequent control of patients with CIED.