What’s New In the 2023 HRS/EHRA/APHRS/LAHRS Statement?

The field of cardiology is a dynamic one, constantly evolving with advancements in technology and healthcare practices. 

The 2023 HRS/EHRA/APHRS/LAHRS Consensus Statement provides examples of how quickly we’re advancing — it highlights valuable insights that reflect the state of remote cardiac monitoring as a whole. 

Let’s dive into the significant changes and updates in the 2023 statement compared to its predecessor from 2015. 

Key Takeaways and Recommendations

The following 11 key takeaways and recommendations come directly from the consensus statement:

1. For patients with cardiovascular implantable electronic devices (CIED), remote monitoring (RM) is the standard of care.
2. 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.
3. 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.
4. Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
5. 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.
6. 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.
7. 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.
8. Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
9. Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
10. Implantable loop recorders require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the implantable loop recorder.
11. Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.

Remote Monitoring Usage Has Increased Significantly

Remote monitoring offers many benefits in the care of patients with cardiovascular implantable electronic devices, reducing morbidity and mortality. 

As such, since 2015, the 2023 consensus statement highlights a significant increase in cardiovascular implanted electronic devices (CIEDs) implanted in patients. The number has grown to 1.7 million people worldwide.

There are two primary reasons for this:

1. The class 1 recommendation in the 2015 HRS Expert Consensus Statement on RM to use RM for CIED patients as standard of care
2. The usage of remote monitoring to facilitate patient treatment during the COVID-19 pandemic

With almost a decade of remote monitoring use behind us, we now have enough backing to say that remote monitoring is beneficial to patient outcomes.

Staff and Personnel Needs

Although the benefits are well-documented, there are some challenges.

As the usage of remote monitoring continues to grow, device clinic personnel are having trouble keeping up with the higher volume of remote monitoring transmissions. 

In a sense, increased remote monitoring hasn’t exactly eliminated work — instead, it has shifted or changed the burden of work. 

Remote monitoring provides valuable information. However, all the information it generates has caused “information overload.” It can be labor-intensive for staff to keep up with reviewing all the information — some of which isn't useful.

To keep up with these changes, device clinic staff need to evolve to meet the unique needs of remote monitoring versus in-person visits. For example, switching from personnel-based to task-based processes.

Privacy Is Of The Utmost Importance

In 2015, the conversation surrounding big data and privacy in healthcare was gaining momentum — it was recognized that data ownership was a complex issue.

The ownership of data obtained through remote monitoring for CIEDs was not clearly defined. There were likely ongoing discussions and concerns about the rights and responsibilities related to this data.

By 2023, the discussion around big data and privacy in healthcare has become even more prominent and nuanced. There has been a shift in the view of data ownership — patients have varying preferences regarding the information they receive about their CIED parameters. 

Some patients want to be informed about all the data, while others prefer a more streamlined report to know everything is okay. 

Both types of patients have the right to receive information about their CIED's function according to their preferences.

New Technology Advancements

A lot can happen in eight years — especially in healthcare technology and remote monitoring.

One of the biggest advancements is the prevalence of implantable loop recorders (ILRs). Though they’ve existed for many years, widespread use of ILRs wasn’t feasible because of their bulk and size.

Today, ILRs are much smaller and are much easier to implant. It’s an ideal device to complement cardiac disease management — ILRs can pick up certain heart conditions, such as nonsustained arrhythmias, that could otherwise be missed.

AI is also on the horizon — concerning labor-intensive information review, AI could prove to be a useful tool to help reduce clinician burnout.

Lastly, “Always on” monitoring standards have become the norm — compare this to 2015, when it was mostly left up to the individual patient plan and care provider.

Read the Full 2023 HRS/EHRA/APHRS/LAHRS Statement for More Information

Looking for the full story?

For all the information you need on advancements in remote monitoring, read the 2023 HRS/EHRA/APHRS/LAHRS Consensus Statement today.