Abstract: Impact of Device Reprogramming Protocols

Amber Seiler

These were two very interesting abstracts to put together, but this will be hopefully very impactful for the AHPs and everyone else in the room who takes care of patients in a longitudinal follow-up way. So, Impact of Device Reprogramming Protocols on Non-Actionable Unscheduled Transmission Burden in a Large Remote Monitoring Population – this was done in conjunction with Novant Health out of Winston Salem, North Carolina.

As a reminder, I just wanted to bring us back to the Heart Rhythm consensus statement from 2023 on remote monitoring for some definitions here. So, scheduled transmissions are programmable, scheduled transmissions during which routine parameters are collected. Non-scheduled transmissions were also defined in this consensus statement, and were separated into patient initiated interrogations and alert initiated interrogations. And then another definition this consensus statement gave us is the definition of an actionable event, and this will become important here shortly.

The other thing that the consensus statement gave us was guidelines on remote reprogramming. And this is incredibly helpful in things that we know that we should do on a daily basis, but we don’t have a lot of data that says how effective is reprogramming, and what are some best practices in how to manage this.

So, for background, non-actionable unscheduled transmissions contribute substantially to operational workload in cardiac device remote monitoring. We know that and live that everyday. Targeted reprogramming is routinely used to reduce inappropriate or low value alerts, but again we have limited data to describe the durability of those interventions, or their association with monthly non-actionable burden. And understanding the real world effectiveness of reprogramming is essential for optimizing staffing and operational efficiency across large device patient populations. And so our objective in this study was to evaluate the reprogramming effectiveness, and reprogramming alerts in the CIED population.

So when we think about the hidden drivers of remote monitoring workflow, those non-actionable alerts certainly rise to the top of the list. We know it’s a major operational burden, and we know that reprogramming is out there and used some. But, we also have unclear durability, and we don’t really understand the population level impact. Another thing that we’re often missing as we evaluate our clinic’s data is how many transmissions are we receiving that are truly unscheduled at baseline. And this is an important thing for clinics to look at globally as you evaluate your patient populations.

So we looked at over 42,000 remote transmissions from over 6,000 cardiac device patients that were monitored in a consecutive 12 month period. Transmissions were classified as scheduled or unscheduled based on Heart Rhythm guidelines. And then, reprogramming events were identified at the alert level, and linked to the individual patient. Then, for each individual alert, we defined recurrence as that same alert that occurred again post reprogramming.

And so, our results were that reprogramming works, but it’s not universal in its effectiveness. 1,162 alert transmissions were associated with a reprogramming intervention. Of these, 60% did not recur after reprogramming. It’s a huge number, and it significantly helps to decrease non-actionable alerts in our clinics. When we look at recurrence rates by alert type, these do vary. So, bradycardia alert recurrence rates were 15.4%, false ILR alerts – and I’ll define that for the audience, our definition of that was an ILR alert that came in that was not clinically adjudicated to be a true arrythmia event – those recurrence rates were 30.7%. And then our AFib alert recurrence rates were 53.9%, and I think as clinicians that makes sense to us. It’s very difficult with the reprogramming tools that we have today to reprogram AFib alerts to get only the information that we want for our patients.

So these were the results in the deceasing of the non-scheduled transmission burden. Non-scheduled transmissions decreased from 53.1% to 34.2% during the study period. All of you can image the effect this has on our workload requirements and our operational requirements within the clinic.

So, reprogramming is necessary, but it’s not sufficient in and of itself. It is durable at the patient and alert level. It does vary by alert type, the success rates of our reprogramming intervention. But sustained improvement requires ongoing, proactive alert management. Reprogramming is a tool, but the workflow is the true solution. It’s enabling our AHPs and our APPs that work in these clinics and manage these devices to have the reprogramming protocols and pathways in place to empower them to make these changes. And clinics seeking to reduce operational burden should prioritize routine alert-based review, and programming optimization as a core operational workflow. Thank you.