Total remote pacemaker follow-up versus standard follow-up reduces global health care utilization

Abstract Background Remote pacemaker monitoring reduces in person pacemaker clinic visits, but a complete remote follow-up could be associated with an increase in total clinical encounters or even admissions, as patients (pts) have less access to a cardiologist or health care provider in a regular basis. Methods Due to a shortage in EP cardiologists between 2009 and 2012 a cohort of 296 pts implanted with a pacemaker, were offered Biotronik home monitoring only follow-up (HM f-p); gradually since 2012, pts came back to usual schedule (once or two a year in clinic follow-up). We matched the same amount of time in HM f-p to standard pacemaker follow-up (STD f-p), aiming to detect any difference in health care utilisation (clinical visits and admissions of all cause). For non de novo implants, the STD f-p period was calculated backwards until pacemaker replacement. Results One third of pts refused, were non compliant or were disconnected early (less than 6 months) to HM f-p only; 200 patients completed a median of 804 days in RM f-p only (range 88–3003 days). Mean age at implant was 74.9 years old (range 22.9–92.3, median 78 y.o.), 57.5% were male and 76% had de novo implants (15% VVI, 82% DDD and 3% CRT-P devices). The median of unscheduled pacemaker visits was 1 (range 0 to 7, 22.5% of pts never required a pacemaker clinic visit during HM f-p). The load of HM messages (number and type -i.e. administrative, clinical and clinical triggering a visit) was similar between both periods of follow-up. During HM f-p there were a median of 3 pacemaker clinic visits saved (range −3 to 16) as expected, but total number of visits were also reduced significantly from a median of 12 (range 1–115) to 8 (0–90) visits p<0.05, between STD f-p versus HM f-P (mean visits reduced from 16.96±16.4 versus 13.91±15.7). Finally, there was not an increase in total admissions between these two periods of f-up (mean of 0.8±1.3 for STD f-p versus 0.4±0.8 for HM f-p, median of 0 hospitalizations for both groups range de 0–8 versus 0–5, p=NS) Conclusion Total remote pacemaker follow-up is feasible in two thirds of patients, and when achieved, it saves in person pacemaker follow-up visits and visits of any cause, without increasing the number of admissions during the same period. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Centre de recherche du CHUS - CIUSSS de l'Estrie

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