Background: Remote monitoring (RM) for implanted cardiac devices has been increasing nationally. At a large tertiary cardiac centre with more than 5,000 patients enrolled on RM, a significant problem is disconnected RM. Disconnected RM can be detrimental, resulting in undetected arrhythmia, battery depletion or lead failure, all of which can result in deterioration in health or mortality. This issue has been exaggerated during the COVID-19 pandemic, as virtual follow ups increased to minimise exposure to the virus. We anticipated that as the increase in RM, would also increase the rate of disconnected RM. Therefore, we approached company representatives (reps) to form a collaborative working relationship to reduce the number of patients with disconnected RM.
Method: We contacted reps from three device companies, approximately 70% of our RM population, three platforms agreed to participate. Limitations for all manufacturers included different GDPR restrictions. One platform wasn’t contacted, as high compliance didn’t require their support. Two companies were allowed read-only access to RM platforms to allow contact with patients, as telephone numbers were documented on all platforms. The third company was provided spread sheets with patients’ name, device, and phone number. All companies received data that was practicable and adhered to GDPR compliance. Prior to reps troubleshooting, Cardiac Scientists ensured data fields were complete and patients were active within the clinic. Reps then called patients to assist with reconnection. If this was not achieved, the issue was reported with discussions had with patients. New transmitters were distributed if required and/or letters and information guides.
Results: The proportion of disconnected RM across two platforms decreased marginally (1 & 2) and one (3) significantly (Table 1).
Discussion: The small proportion reduction of disconnected RM patients on 1 and 2 can been attributed to the high volumes of patients enrolled during the pandemic. The 3rd platform only consists of ILR patients. For that reason, few RM were provided during the audit period, resulting in a significant decrease in disconnected RM proportion. Whilst triaging for platform 3, we discovered 124 patients’ devices had reached end of service, been removed and had not been removed from the platform. This highlighted a gap in communication, which we have now resolved. Following discussions with reps, a few simple troubleshooting approaches solved the majority issues. Including: pressing status or reset button to re-establish connection, moving the monitor closer to a window for improved signal or switching the 4G dongle port. Some patients were unaware that RM needed to be plugged in constantly. Maintaining a low burden of disconnected RM is necessary to allow future RM only follow-up. There is therefore a need to improve Cardiac Scientist training to alleviate the disconnected RM burden to continue this project to achieve a disconnected rate of 0%. In conclusion, reducing disconnected RM during the COVID-19 pandemic has been a success. Demonstrating that collaboration with RM platforms could be achieved to decrease the disconnected RM burden. We would like to thank the representatives at Boston Scientific, Abbott and FocusOn for their help and support during this project.