Remote monitoring of pacing technologies in heart failure (HF) patients has the potential to transform the workload for pacing departments. The Medtronic Carelink network is a web-based remote monitoring system for implantable devices that provides information identical to that obtained at a pacing clinic visit. We evaluated the impact of the introduction of this system into routine practice.
Methods and Results A retrospective audit of all HF patients with cardiac resynchronisation therapy devices (CRT-D) who were established on Carelink follow-up in the 15-month period from September 2007 in one centre was performed by review of case notes and pacing clinic records. 97 patients were included (mean age 66 years (range 28–87), mean period on Carelink 10 months (range 2–15 months)). Two patients died during that period. According to the standard pacing clinic follow-up protocol, “expected” pacing clinic visits over the audit period was estimated to be 292. “Actual” scheduled pacing clinic visits that occurred using the Carelink system in the audit period was only 87, a 70% reduction in the need for scheduled pacing clinic visits. There were 104 “scheduled” Carelink downloads during the audit period: this led to no action in 87 instances (84%). 17 downloads (16%) required some action: one was related to rising lead impedance, one implantable cardioverter defibrillator (ICD) discharge not noticed by the patient, 10 were rhythm-related and required medical review, and five were related to increasing atrial fibrillation “burden”, or decreasing transthoracic impedance (Optivol) readings, with involvement of the HF team. There were eight “unscheduled” Carelink downloads, all but one triggered by a patient (three ICD discharges, two lead “alerts” from the device, and two related to decreasing transthoracic impedance). Of the 87 scheduled pacing clinic visits, only nine (10%) led to any action—seven were rhythm-related, which resulted in medicine review and/or reprogramming of the device and wto related to transthoracic impedance reductions. There were 22 “unscheduled” office visits, organised by the pacing clinic as a result of Carelink downloads or patient telephone contact, which led to action in 20 cases (91%). These were due to syncopal episodes (2), lead alarms (2), ICD discharges (2), rhythm disturbances (8) and six were due to changes in transthoracic impedance or other HF-related parameters.
Conclusions Remote monitoring of implantable devices in HF patients shows considerable promise in reducing the need for routine pacing clinic visits. In the vast majority of cases alerts from patients (or the device) require action. The widespread adoption of remote monitoring is likely to improve the use of healthcare professionals’ time, and will free up patients from the need for more frequent “routine” visits to the pacing centre.
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