10Remote monitoring of ILRs, when is more too much?

Abstract

Introduction: Remote monitoring has become an accepted and utilised tool for use with implantable cardiac devices: with safety at heart it is easy to see why when it comes to implantable defibrillators. The same is not so evident for implantable loop recorders (ILRs). This paper explores the impact of remote ILR monitoring on cardiac departmental workload. Method: Patients receiving an ILR at a single implanting centre were recruited. Following informed consent, they were randomised to control or experimental groups. Patients in the control group were reviewed by 6 monthly follow‐up plus additional ad hoc checks if symptoms occurred. In‐office follow‐up, routine or ad hoc is allocated 30 minutes. In the experimental group, patients were asked to send transmissions fortnightly or following a symptom. Remote follow‐ up appointments were allocated 20minutes; this included contacting the patient by telephone unless prior arrangements were made with the patient to send them a letter if there were no abnormalities. The primary outcome variable, which is reported separately, was median time to clinical diagnosis. Results: There were 37 patients were randomised, 19 to the control and 18 to the experimental group. The control group comprised 11 males and 8 females with a median age of 60 (36‐86) years. The experimental group comprised 10 males and 8 females, median age 58 (36‐84) years. Over the median 9 (0‐23) month follow‐up period, 23 (67%) of patients received a diagnosis based on ILR output. In total the study produced data from 5526 events (total with and without ECG) for review in the analysis. This equated to 1711 ECG recordings requiring review and 3815 text recordings. When breaking down the 5526 recordings into recordings per study group there were 1264 events logged for the control group, 481 with ECGs and 783 without ECG to review and 4262 events logged for the experimental group, 1230 with ECGs and 3032 without ECG to review. 122 (25%) of the ECGs recorded in the control group were classified as true events compared to 153 (12%) in the experimental group. In total here were 362 follow‐ups carried out, 65 for the control group and 297 for the experimental group. Calculated into hours of follow‐up time, that was 32.5 hours for control and 99 hours for experimental. Conclusion: With a threefold increase in both the amount of data requiring review, and the amount of time required to follow‐up ILRs remotely, the process would have to be streamlined in order to make it a viable option. However, with the study data suggesting that a significant reduction in patient diagnostic time can be achieved, investment in service improvement should not be overlooked.