From in-clinic to fully remote follow-up model for pacemaker patients: A four-year experience

Background: Guidelines on remote monitoring (RM) still suggest at least 1 in-person visit per year for all remotely followed patients, including pacemaker patients. Methods: The RM of pacemaker patients was systematically introduced in our clinic since January 2013. Patients without RM were visited 2 months after implantation and afterwards annually. Subjects with RM had in-person visit only at 2-month follow-up and at device replacement. Results: At the end of 2016 a total of 2233 patients (mean age 81.4 ± 9.9 years, 55% male) were followed by our centre. The patient population had a mean annual growth of 2.8 ± 2.3% with an incidence of RM increasing from 0% in 2012 to 45% in 2016. The in-clinic visits significantly decreased from the second year (I year: −12, 0%; II year: −324, −17%; III year: −276, −17%, IV year: −127, −10%). The annual incidence of unscheduled ambulatory visit for patients with RM was 15.9 ± 2.9%, mainly triggered by device reprogramming, transmission problems and autocapture deactivation. There was no effect on the incidence of serious adverse events and mortality. Conclusions: This fully remote follow-up model for pacemaker patients reduced in-clinic visits since the second year from its implementation in our clinical practice. This strategy may increase the organizational benefits of RM in low-risk patients.