May/June 2024

May/June 2024 Issue

Durable Medical Goods: Remote Monitoring for Implanted Heart Devices
By Keith Loria
Today’s Geriatric Medicine
Vol. 17 No. 3 P. 8

Cardiac device remote monitoring optimizes care for patients with cardiac devices as it allows clinicians to monitor heart rhythm and device health while patients remain in the comfort of their own homes—a huge convenience that also reduces the need for frequent in-office visits and hospital visits. It’s a significant benefit for geriatric patients who have mobility issues or are too severely immunocompromised to be exposed to clinics and hospitals.

“In recent years, the amount of information these devices can collect and transmit has increased substantially, ensuring critical patient data for alerts and episodes is captured through patients’ smartphones or bedside monitors,” says Kevin Hoffman, founder and CEO of Vector Remote Care. “While this is not a real-time monitoring capability, the insights and transmission data these devices provide to care teams can be leveraged to enhance patient care greatly.”

Multiple research studies demonstrate the benefits of remote monitoring and its impact on improving all-cause mortality, decreasing the time to diagnosis, promoting faster care intervention, and reducing the number of hospitalizations and time spent in the hospital. However, Hoffman points out that cardiac device patients only receive these benefits if they are continuously connected to their remote monitors.

“Remote monitoring removes the patient compliance and bother compared with monitoring techniques using a wearable device,” says Adam Jacobs, chief technology officer of Sunrise Labs, a Bedford, New Hampshire–based company, designs implantable cardiac and other monitors, as well as pump controllers for other medical device companies. “The patient does not need to do anything. As such, compliance rates are improved since issues with wearables such as placement, cleaning, storage, and losing the device are mitigated.”

“Connectivity to a computer server needs to be set up and maintained, usually through phones or internet routers,” Jacobs says. “Then the data must be dispersed to data users such as patients and clinicians. With an older user base, providing support to set up and maintain connectivity in an easy way is needed.”

Evolution of Implanted Heart Devices
In earlier times, before the use of video became the norm, patients would need to read off the data collected to their caregivers in place of making on-site visits. Now, modern implanted devices have wireless technology that helps clinicians get data from patients at home via cellular networks.

Pacemakers and implantable cardioverter-defibrillators (ICDs) are implantable devices that allow for remote monitoring and are the most used systems.

“Initially these devices were developed with the purpose of cardiac pacing (pacemaker) or defibrillation for unsafe cardiac rhythms (ICD),” says Rohit Vuppuluri, DO, FACC, RPVI, a double board-certified interventional cardiologist and partner at physician-owned Northwest Vascular Cardiologists in Chicago. “Over time, however, these devices have become significantly more technologically advanced and are now able continuously monitor heart rhythm and send this data wirelessly to a home transmitter, which then sends the data to a central monitoring site where the rhythms are monitored and interpreted.”

Today, any concerning rhythms can be quickly and securely sent to the patient’s physician for prompt medical diagnosis, guidance, and treatment.

“Patients with implantable cardiac devices have the distinct benefit of having a 24/7 real-time cardiac monitoring, immediately alerting the physician when abnormal rhythms are detected,” Vuppuluri says. “This can be especially important for the detection of atrial fibrillation or adverse ventricular rhythms.”

The best option for a patient is recommended on a case by case basis, after evaluation. However, Vuppuluri notes the best options are pacemakers, ICDs, and loop recorders, with loop recorders being the best for cardiac monitoring.

“More specifically, pacemaker and ICDs are often implanted for other cardiac reasons and can then also be used as a cardiac monitor,” he says. “In contrast, loop recorders are implantable devices developed solely for recording cardiac rhythm. These small devices, easily implanted, monitor cardiac rhythm for three to five years. The loop recorder will also transmit its data to a central monitoring station via a home transponder. This loop recorder is very beneficial for any patients requiring long-term cardiac monitoring.”

Recent technological advances in cardiac monitoring have allowed for implantable devices to become smaller, more accurate, and less cumbersome to the patient. Loop recorders are easily placed, and patients even quickly forget they have the devices implanted. The data from the loop recorder is very accurate and can be trusted by physicians for clinical management.

Challenges for Device Clinics
Ensuring the clinical value of the collected data is key to success with these devices. Hoffman, whose company helps device clinics adopt remote monitoring strategies to thrive in a patient data-rich environment, notes cardiac device clinics care for patients who have received implantable cardiac devices, including pacemakers, defibrillators, loop recorders, and pulmonary artery pressure monitors. The typical practice in the United States follows hundreds, if not thousands, of patients.

“Implantable cardiac devices help to detect and treat dangerous arrhythmias,” he says. “To remain effective, they must be remotely monitored as part of ongoing care to manage serious cardiac rhythm diseases and progressive conditions.” However, there’s a downside. While the benefits of remote monitoring are key to personalizing care and informing future care decisions, the volume of patient data that must be collected and triaged is overwhelming.

“Quickly, and through no fault of their own, device clinics are becoming burdened by a patient ‘data deluge’ that grows larger and more difficult to manage daily,” Hoffman says. “Since this highly technical patient information requires a skilled and licensed technician or clinician to review, interpret, and triage before it can be cleared or escalated to physician review, device clinics must quickly adjust to modernize and adopt sustainable strategies to resolve this growing challenge.”

Remote monitoring transmissions contain a lot of information, and discerning what is important is a time-consuming challenge. Vector’s remote monitoring solution leverages a feature known as SmartReports to create a software-assisted summary, highlighting key takeaways from each transmission that align with the clinic’s protocols.

“Most scheduled remote monitoring transmissions are not actionable, meaning the patient and cardiac device do not require clinical intervention like scheduling an in-clinic visit for device reprogramming or a medication change,” Hoffman says. “Our solution takes it further to color-code summary reports to escalate patients requiring immediate intervention above the noise of nonactionable transmissions.”

Patient Resistance
Patients who require long-term cardiac monitoring are often reluctant to have a loop recorder, with concerns including the implantation procedure itself, risk of infection, and comfort. However, these fears are often quelled with a conversation with the cardiologist who can explain that the procedure has become commonplace and the benefits significantly outweigh the minimal risk.

“It is important to understand why the cardiac device is being implanted and how these devices will help the patient,” Vuppuluri says. “For pacemakers and ICDs, the devices are implanted for other cardiac reasons but have the benefit of long-term cardiac monitoring,” he adds. “Loop recorders are small, easily implanted devices that offer great cardiac rhythm monitoring.”

— Keith Loria is a D.C.-based award-winning journalist who has been writing for major publications for nearly 20 years on topics as diverse as real estate, travel, Broadway, and health care.