Remote monitoring of implantable cardiac devices at the cardiology department of cirie' hospital, a retrospective observational study

Abstract Introduction International guidelines recommend remote monitoring (RM) of implantable cardiac electronic device (CIEDs) as a substitute for in-hospital follow-ups (1). Several studies indicate that RM offers numerous advantages: primarily, benefiting the patients, by enabling closer monitoring, and benefiting hospital by reducing the resources required for outpatient care(2). The Italian Association for Arrhythmology and Cardiac Pacing (AIAC) has developed a specific organization model, the "Primary Nurse Model", to manage remote monitoring of the CIED. This model, recommended by the European Guidelines, places nurses at the core of patient care management with a CIED(3). Purpose To describe the activity of the Remote Monitoring program at the Cardiology Centre in our Hospital. Methods Our Cardiology Centre applies the "Primary Nurse Model" to review CIED transmissions, as recommended by the AIAC. Within this model, nurses are responsible for managing device transmissions, enrolling patients in the RM program and conducting follow-up phone calls. Physicians are responsible for reviewing and signing the medical reports derived from the transmissions. Results Since 2011 we have enrolled 1,602 patients in the RM program. Table 1 presents the distribution of CIEDs among the enrolled patient population. Patients with pacemakers (PMs) or Implantable cardioverter defibrillators (ICDs) undergo transmission reviews every three months, while those with loop recorder are reviewed monthly. Our team manages 36,447 transmissions per year of which 83% are independently handled by the nurses. However, 17% of transmissions have on outcome that requires a physician intervention, follow-up phone calls, a GP follow-up, an in-hospital follow-up or hospitalisation. Table 2 categorizes the type of intervention required based on the outcome and the reported issue. Conclusion Our Remote Monitoring program effectively replaces standard in-hospital follow-ups, significantly reducing hospital workload. During the Covid-19 pandemic, RM proved particularly beneficial as it allowed us to continuously monitor patients even when routine in-person visits were suspended. The Italian National Health Service officially included RM in the Essential Levels of Assistance (LEA) only in 2020. This integration has enabled our hospital to enhance continuity of care for patients with a CIED, aligning with the latest European Society of Cardiology (ESC) Guidelines.Table 1 Table 2