Video visits are just one way telemedicine is making medical care safer and more accessible. But here’s another telemedicine advance to put on your radar, especially if you’re among the more than 1.7 million adults in the U.S. with a implantable cardioverter defibrillator (ICD), or other implanted cardiac device, such as a pacemaker, or implanted cardiac monitor–loop recorder: Remote cardiac device monitoring. If you have an implantable medical device, remote monitoring allows your healthcare team to monitor your heart health and the function of your cardiac device without you having to be physically present. “The technology has actually been around since 1971,” says Lindsey Rosman, PhD, an assistant professor of medicine in the division of cardiology at the University of North Carolina (UNC) School of Medicine in Chapel Hill. “In the early days, it wasn’t easy to use and we didn’t have the infrastructure to support it.” But in 2001, things started to change, Dr. Rosman says. That’s when cardiac devices began using wireless technology, which allowed patients to easily connect with their healthcare providers. “And in the last couple of years, there has been a huge push to get patients on remote device monitoring because we’ve seen the data from observational studies and clinical trials, which suggests there are a number of benefits to the patients.”
Why Remote Cardiac Device Monitoring Matters Now More Than Ever
One of the most important benefits of remote cardiac device monitoring is that it cuts down on routine doctor visits. Without remote monitoring, patients must visit the doctor every three to six months (depending on device type) for a data download. With remote monitoring, the number of visits drops to one to two per year. “Remote cardiac device monitoring is a fantastic way to follow patients and it has always been important, but it’s especially important in this era of COVID-19,” says Merritt Raitt, MD, director of the VA National Cardiac Device Surveillance Program in Portland, Oregon. People with heart disease are at high risk for serious complications from COVID-19. To reduce your risk of contracting coronavirus, telemedicine options such as remote monitoring can reduce the need to visit a doctor’s office or hospital filled with sick patients, especially for a routine follow-up visit.
Remote Monitoring: Here’s How It Works
An implanted cardiac device, such as an implantable cardioverter defibrillator (ICD) or a pacemaker, is essentially a small computer that collects data throughout the day and night, springing into action when necessary. If an ICD detects a dangerous rhythm because your heart is beating too fast, for example, the device will deliver a therapy — a high energy shock directly to your heart to restore a normal heart rhythm and prevent sudden death. Traditionally, with the wave of a wand, data from an implanted cardiac device is collected and downloaded during a routine office visit every three to six months, which provides your doctor with a history of the device’s electrical activity. If you’ve needed a high energy shock during that time, your healthcare team would learn about it retroactively. But with remote cardiac monitoring, the information is communicated to your healthcare team in real time using wireless technology and a Bluetooth-enabled device. Patients with an implanted pacemaker or defibrillator are given a monitor, a small transmitter to keep at home, which communicates with the cardiac device wirelessly. “We tell patients to put it under their bed because that’s a place where people at home spend a substantial amount of time,” says Rosman, who noted that patients need to be within 10 feet of the monitor for it to pair with a cardiac device. Every night around 2 a.m. (when most people are in bed), your device and monitor are programmed to “wake up” and transmit information. If you’re not near the monitor at that time, the two devices will try again every two hours until the information is captured. If your cardiac device recognizes a heart rhythm problem or a problem with the device, such as a low battery or an issue with one of the device’s leads, it will send a message to the monitor, which then uploads that information to the central servers at the medical manufacturer of the device. From there, healthcare providers can review the findings by logging into a highly secure, password-protected, HIPAA-compliant website from the clinic or even their own home computer, if necessary. “We can also set up text or email alerts to let us know if patients are having certain abnormal rhythms that may be dangerous, or if heart failure patients are putting on too much water in their lungs,” Rosman says. The upshot? With remote cardiac device monitoring, heart rhythm problems can be detected and treated much earlier than they would without the constant surveillance. “Remote monitoring technology allows us to be proactive with patient care and make adjustments so patients can stay out of the hospital and live a healthier life,” Rosman says.
Studied Benefits of Remote Cardiac Device Monitoring for Patients
Research shows having real-time information can offer several advantages for people with heart failure and heart rhythm disorders, including fewer ICD shocks. A study published in 2018 in the Ontario Health Technology Assessment Series, for example, which evaluated 15 randomized control trials, found that remote monitoring plus clinic visits resulted in fewer patients with inappropriate ICD shocks within 12 to 37 months of follow-up. Remote cardiac monitoring may also reduce the chances you’ll end up in the hospital. A study published in January 2016 in the Lancet, which randomly assigned 550 patients with heart failure to either disease management guided by an implanted sensor device (and daily downloads of blood pressure readings in the main pulmonary artery) or the standard of care (no daily downloads) — found there was a 33 percent decrease in hospitalizations due to heart failure over an average of 18 months in the device group. Remote monitoring may also translate to living longer. A study published in June 2017 in the European Heart Journal, which pooled the results of three major randomized controlled trials, found that daily remote home monitoring of implantable defibrillators reduced the risk of hospitalization or death as a result of worsening heart failure, compared with patients without remote device monitoring. RELATED: 3 Keys to Cutting Your Risk of Heart Failure
How to Stay Connected to Your Healthcare Team
Remote cardiac device monitoring is covered by Medicare and Medicaid, and by most private insurance plans, so it comes at little to no cost to patients. However, the amount of reimbursement may vary by state. The main drawback for patients is getting familiar with the transmitter — and getting the kinks out of using the technology. “Patient education is critical. Patients need to understand how this technology works,” Rosman says. After plugging in the device at home, connected by a cellular service to the central server, you don’t have to do anything. “But unfortunately, as with most technology, it doesn’t always work,” Dr. Raitt says. Having weak cell service at home, especially in your bedroom, can knock you offline. “There are all kinds of ways communication can break down. I spend a lot of time calling patients and saying, ‘You’re not online. Let’s try to figure out why.’” Some patients decline remote cardiac device monitoring due to security concerns. They worry that the device could be hacked or the transmitter can know what the user is doing in the bedroom. But those are all misconceptions. The transmitter is simply a relay station. “It can’t be reprogrammed to deliver an unprescribed therapy and it has no idea what you’re doing and who you’re with,” Rosman says. One of the biggest barriers to getting connected to the technology may lie with your doctor’s office, however. “If a clinic is going to start doing remote monitoring, they have to devote resources to it,” Raitt says. In other words, remote monitoring costs money. A healthcare provider has to monitor the onslaught of patients’ remote cardiac device transmission data and text alerts, and make sure patients are online when they’re supposed to be, which is Raitt’s full-time job. “It takes effort on the part of the provider to set up a remote monitoring program and keep it working,” he says. For that reason, providers may not offer remote cardiac device monitoring to their patients. In some instances, especially if they practice in a state with low reimbursement rates for remote cardiac device monitoring, offering the service could be a revenue loser. Still, if you’ve been diagnosed with a cardiac condition that requires a pacemaker or defibrillator and it’s available at your doctor’s office, your doctor should talk to you about remote monitoring before the device is implanted, while you’re recovering in the hospital after the initial implant procedure or during your post procedure follow-up appointment. In fact, the Heart Rhythm Society, a leading professional heart failure organization, recommends that all patients with implanted cardiac devices be offered remote monitoring as part of the standard follow-up management strategy. In January 2020, the Veterans Health Administration also issued a directive that all patients followed in the Veteran’s Administration who have pacemakers and defibrillators should be offered remote monitoring, if they are willing and able. The national database of pacemakers and defibrillators followed in the VA system is also vital to the VA’s response to FDA and manufacturer recalls and alerts. “Our national database of implanted devices allows us to notify clinics that they have patients affected by recalls and if appropriate, monitor the local clinics’ response to the recall,” Raitt says. “Remote monitoring is beneficial to most patients,” Rosman says. If you have an implanted cardiac device and you’re not enrolled in remote monitoring, talk to your cardiologist about whether you’re eligible for it, she urges. Nearly all modern implanted devices are capable of remote monitoring. “Most devices have built-in Bluetooth technology that allows them to wirelessly collect data from the cardiac device and transmit it to the clinic. Some newer devices even allow patients to use a smartphone app rather than a home monitoring device to send their remote monitoring transmissions,” Rosman says. Even if you’re among the small number of patients with an older pacemaker without Bluetooth technology, you may be able to perform remote monitoring manually. On the day of your scheduled transmission, you would simply hold a wand over your device for a short period to send information from your cardiac device to your cardiac clinic. Overall, remote cardiac device monitoring is a game changer that’s more important than ever because patients can be monitored from the safety and comfort of their own homes. “The current pandemic has really reinforced the value of this technology to patients, providers and healthcare systems,” Rosman says. David Slotwiner, MD, chief of the division of cardiology at NewYork-Presbysterian in Queens and a trustee with the Heart Rhythm Society, agrees. “The best incentive to try remote cardiac device monitoring is the pandemic,” he says. “For patients who have been holding out on trying remote cardiac device monitoring or providers who have been reluctant to offer it, COVID-19 may be what pushes them over the edge.” Plus, many patients who’ve tried remote cardiac monitoring like it. “Having a defibrillator or a pacemaker can be scary,” Raitt says. “Patients like the security of knowing everything is okay and if there’s something wrong, they’re going to hear about it right away.” RELATED: The Telemedicine Tipping Point Is Here
