5 Takeaways from New Clinical Research in JACC: CEP—Analyzing Remote Monitoring Management Burden

by Jason Hale, CCDS, PaceMate Co-Founder and Vice President of Commercial Excellence

Last month, Dr. Catherine J. O’Shea, et al., published in JACC: CEP a robust analysis of device-generated data, using the PaceMateLIVE software and data analytics platform.

The study analyzed a cohort of 26,713 CIED patients and took place over twelve months (November 2018 – November 2019). The following discussion points summarize the results of the research which highlight the need for new management pathways for remote monitoring.

1. Remote monitoring (RM) of CIEDs is now solidly considered a standard of care.

Remote monitoring of CIEDs is an ongoing process that occasionally requires a timely clinical response to patient and device events. The advantages of remote care are numerous, including fewer in-person evaluations, reduced need for unnecessary hospitalizations, reduced cost to patients and clinics, and mortality benefits.

2. RM can be clinically onerous and causes a significant staff burden to manage the numerous transmissions and alerts that occur 24/7/365.

Modern CIEDs are hyper-connected and capable of daily remote transmissions. Device and patient alert volumes are on the rise due to the increase of loop recorder implants and Bluetooth connectivity. Since the CIED population is expanding and because every individual CIED remote transmission requires attention, the labor burden for patient care is also dramatically increasing.

3. PaceMateLIVE utilizes proprietary alerts logic.

Each CIED manufacturer has different capabilities and methodologies regarding alerts. With PaceMate’s proprietary clinical alerts rules engine, 98% of all CIED alerts are applied automatically based on HL7 data. This gives clinicians immediate knowledge of which reports are most urgent on their dashboard and which have less clinical relevance. PaceMate has built specific alert templates for each device type, with customizable alert settings for specific messages and colors based on any combination of data—HL7, API-delivered EHR data and/or data points selected manually by the clinician or doctor.

4. Alert severity varies by device type.

Data analysis for this study determined that 95.2% of alerts were yellow alerts, while 4.8% were red alerts. Loop recorders transmitted the highest number of alerts per device. Most red alerts were transmitted from ICDs and CRT-Ds. AF alerts accounted for the highest number of red and yellow alerts and the highest overall alert volume.

5. Alert frequency varies by device type.

Within the data set studied, the highest frequency pacemaker alerts were due to high ventricular rates (41%), with a majority of these found to be relatively benign sinus tachycardia or SVT events, occasionally revealing sustained VT. The most frequent ICD alerts were due to VT or VF episodes (29%), while the most frequent loop recorder alerts were due to patient-initiated “symptom” episodes (27%).

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