by James Allred MD, FACC, FHRS
Alerts from cardiac implantable electronic devices (CIEDs) are crucial for patient care. However, the sheer volume of alerts, many of which do not necessitate action, can overwhelm healthcare professionals and lead to “alert fatigue.” To mitigate this problem and enhance patient care, we need to focus on optimizing device alert management.
Allred’s Rule of 3: An Effective Strategy
This “Rule of 3” is a unique strategy I have found to be effective during my years of clinical practice. And you heard it here first! Rooted in practicality, this strategy has consistently proven highly effective in reducing non-actionable alerts, enhancing the overall efficiency of device management.
The essence of the “Rule of 3” is simple yet powerful: if an alert is triggered three times consecutively, then something needs to be addressed. There are three potential scenarios:
- Genuine Clinical Issue: Immediate action is required to address the patient’s medical situation. (Ex. New onset #afib, sustained VT)
- Device Malfunction: The device must be interrogated and reprogrammed/ revised to ensure accurate functioning. (Ex. Lead fracture, ERI)
- Non-Actionable Alert: If neither the patient’s condition nor the device is the issue, the alert is deemed non-actionable and alert settings should be adjusted or deactivated. (Ex. Known afib already managed, ventricular high rates VHR in a pacemaker)
Applying the “Rule of 3” helps clinics focus their resources on managing alerts that are indicative of real, actionable issues. This approach is particularly beneficial for “frequent flyers” who generate a high volume of alerts.
Finding the needle in the haystack is easier with a smaller haystack!
Customization and Patient-Specific Programming
Individual patient needs should guide alert programming. For instance, alerts should be set to reflect the fluctuations in a patient’s cardiac performance due to their lifestyle or comorbidities. This personalization can significantly reduce unnecessary alerts, improve patient outcomes, and save costs by minimizing unnecessary hospital visits or interventions.
Clinical Pathways and Protocols
Clinical pathways and protocols can further optimize alert management by identifying which alerts require immediate attention and which can be safely disregarded or reprogrammed (references 1 and 2 below). Standardizing the approach to alert management ensures everyone is on the same page and reduces the risk of critical alerts falling through the cracks.
Training and Education
Training is vital for effective alert management. Healthcare providers should be well-versed in device alerts and their implications, management strategies, and the application of the Rule of 3. Regular training sessions, clear standard operating procedures (SOPs), open communication, and case-based learning can all play crucial roles in elevating staff proficiency in alert management.
Collaboration is also critical. Different specialists should work together, with the EP team setting alert management expectations and educating other providers about the limitations of alert management. Close cooperation between #cardiology, #heartfailure and #EP teams can lead to more efficient care and better #patient outcomes.
The Future of Alert Management: The Role of AI
#Artificialintelligence (#AI) presents promising potential in alert management. By analyzing data from devices and identifying patterns, AI could presumably automate the process of discerning actionable from non-actionable alerts. However, AI should complement rather than replace human judgment and expertise- and is several years away at best. Future directions in this field include advanced machine learning algorithms, natural language processing (NLP), and wearable devices for more accurate and continuous #patientmonitoring.
Industry Partnership and Alert Management
A crucial but often overlooked component of effective alert management is collaboration with #industry representatives. As the individuals present during device implantation or office follow-up, they can contribute significantly to minimizing false alerts through paying attention to device programming. On reviewing thousands of transmissions across clinics nationwide, I have observed clear differences among the four device vendors in terms of the volume of false alerts generated, highlighting the importance of active engagement with industry representatives.
The Economic Impact of Reducing Non-Actionable Alerts
Effective alert management can have a significant economic impact on #healthcare. With fewer alerts to manage, clinics can allocate resources more efficiently, leading to cost savings for both the clinic and the #patient. Reducing unnecessary #hospitalizations or emergency room visits through better #alert management helps patients avoid excessive medical bills. Our recent abstracts have demonstrated the effectiveness of our tailored approach in reducing non-actionable alerts (references 1,2).
The Urgency of the Situation
As healthcare technology evolves and the number of implantable devices increases, physicians must take proactive steps to tackle the potential explosion of #non-actionable alerts. At CV Remote Solutions , we provide education and training to device clinic teams and work collaboratively with clinicians to develop effective pathways. We also speak nationally on the topic and work with EP fellows to increase understanding of device management optimization.
Conclusion
Device management, and specifically #alertmanagement, is crucial for patient care and significantly impacts patient outcomes and healthcare costs. Our tailored approach, including the Rule of 3 and patient-specific device programming, has proven effective in reducing non-actionable alerts, thus easing the burden on healthcare providers. As we look to the future, AI and advancements in machine learning algorithms promise further refinements in alert management strategies. Ongoing education, training, and collaboration remain essential as we continue to innovate and improve patient care.
For more information visit our website at www.cvremotesolutions.com
Resources:
1. Bodziock G, Seiler A, Dillon J, Cotton L, Allred J, Bhave D. Optimizing Alert Protocols for the Remote Monitoring of Cardiac Electronic Implantable Devices. JACC 2023 Mar 81 (Supplement 8), 94.
2. Seiler A, Ray K, Hibbs E, Allred J, et al. Strategic Protocol of Remote Programming of Insertable Cardiac Monitors for Reduction of Alert Events. JACC 2023 Mar, 81 (Supplement 8), 2340.
3. Allred J, Van Heel L, et al. Current Practices In The Follow-Up Of Cardiac Device Patients: An International Survey Of Device Clinic Staff. Heart Rhythm 21 (5): Supplement S116-117, May 2024.