The first implantation of a pacemaker in a human occurred in 1958. Since then, the technology behind permanent cardiac rhythm management has steadily evolved, enabling a variety of implants known collectively as cardiac implantable electronic devices (CIEDs). Today, CIEDs are the standard of care for a range of cardiac arrhythmias, and researchers estimate that 1.2–1.4 million of these devices are implanted annually worldwide. And experts predict that number will continue to increase in years to come.
Along with continued miniaturization and increased battery longevity, one of the most important technological advancements in CIEDs has been the addition of remote monitoring capabilities. When they are equipped with remote monitoring devices, CIEDs can transmit data that allows healthcare providers to keep a close eye on not only their patients’ cardiac health but also how well the device itself is functioning. This level of vigilance has been shown to reduce the time to detect clinical events, improving survival rates and reducing hospitalizations linked to arterial arrhythmias. Remote monitoring also alleviates the data burden on cardiac patients, improving their quality of life. Traditionally, remote monitoring of implants occurs via radio frequency (RF) communication but increasingly, CIEDs are integrated with Bluetooth technology and smartphone applications.
Despite the growing importance of remote monitoring of patients with CIEDs, and the increasing ease with which it can occur, it is not uncommon for these devices to become disconnected. In fact, remote patient monitoring solutions provider Implicity estimates that as many as 19% of patients with CIEDs are not transmitting and that 70% of the medical centers count at least 10% of non-transmitting patients.
A CIED can become disconnected for a variety of reasons. For instance, the CIED may simply be malfunctioning. Or a patient may go on vacation and forget to bring along the transmitter. Or the smartphone application may experience connectivity issues, particularly in remote areas that lack or have limited internet access. Lastly, some patients may opt-out of monitoring because of the co-pays that are sometimes associated with it or for some other reason entirely.
Regardless of why a patient becomes disconnected from their CIED, it is up to the healthcare provider’s office to figure out what has happened and to follow up accordingly—and that can be quite burdensome for the provider’s office staff. Contacting and then managing patients who become disconnected from their CIEDs typically involves multiple manual steps, such as phone calls, emails, or letters. The time involved adds up quickly, increasing already heavy workloads and consuming resources that could be devoted to other patient needs.
What can be done to remedy the problem of patients disconnected from their CIEDs?
First, patients with CIEDs need more education about the value of remote monitoring. Available since the 1970s, remote monitoring of cardiac implants has been shown repeatedly to significantly improve survival and reduce mortality. Cardiac patients need to understand the importance of remote monitoring and the steps necessary to ensure that their devices stay connected. Building awareness and encouraging engagement in the patient population is key.
Second, technology can help. Currently, device manufacturers do not send an alert when a patient’s device stops transmitting information for any number of reasons. As a result, the provider’s office often must spend considerable effort tracking down the patient to determine why the device became disconnected and how monitoring can resume. Technology in the form of patient-friendly tools or texts could help speed this communication and get CIEDs re-connected faster.
The volume of cardiac patients receiving CIEDs with remote monitoring capabilities continues to grow. That means healthcare providers are likely to face mounting issues caused by disconnected devices. When CIEDs become disconnected from their remote monitoring capabilities, patient care suffers. In addition, it is usually difficult and time-consuming for healthcare providers to track down what has gone wrong. Being able to quickly address and remedy the multi-dimensional problem of CIED disconnection is going to be increasingly essential for patients and providers alike.
About Dr. Rosier
Dr. Arnaud Rosier is an electrophysiologist with a PhD in health informatics. His second doctorate was co-directed by Pr. Anita Burgun and Pr. Philippe Mabo at INSERM laboratories. Both of them still collaborate with Implicity and are members of the scientific advisory board. Following positive results in remote monitoring automation, Arnaud created Implicity in 2016 to fully optimize remote monitoring and improve patient care outcomes. With 15 years of experience in cardiac electrophysiology and 12 years in artificial intelligence and knowledge engineering applied to health, Arnaud is the author of a dozen international publications in peer-reviewed journals, notably on telecardiology and AI supporting medical decisions. Arnaud is also an angel investor of digital health companies including Cardiologs, Lifen, Ambuliz, Biloba etc. Arnaud occupies the position of CEO at Implicity.