By James Allred, MD, FACC, FHRS and Amber Seiler, NP, FHRS
An international survey of 471 device clinic staff across 44 countries — which we co-authored with colleagues at Stanford, the Technical University of Munich, Nottingham, Southampton, Deloitte, and Medtronic — found that while 71% of respondents are aware of the 2023 HRS/EHRA/APHRS/LAHRS consensus on remote device clinic management, adoption of the recommended practices remains highly variable. The technology is in place. The execution is not.
If you spend any time in a device clinic, you see it quickly. There’s a difference between how care is designed to work and how it actually plays out day to day. We recently looked at how cardiac device clinics around the world are managing remote monitoring. The goal wasn’t to prove a point. It was to understand what’s really happening in practice.
The findings confirmed something many of us already know. We’ve made meaningful progress in technology and clinical guidance. Execution is still highly variable.
What the Survey Found
The survey collected responses from 471 device clinic staff across 44 countries: 310 in the United States, 88 in Europe, and 73 in other regions. Among the findings:
- 71% of respondents were aware of the 2023 HRS/EHRA/APHRS/LAHRS consensus statement on remote device clinic management
- 77 to 83% use a hybrid in-person and remote management approach for patients with therapeutic CIEDs (pacemakers and ICDs)
- 89 to 91% schedule at least one routine office visit per year, depending on device type
- Only 50% use a hybrid approach for insertable cardiac monitor patients, and 35% report remote-only follow-up. ICM management shows substantially more variation than therapeutic device management.
- On staffing, 43% of respondents rated their staffing as somewhat or very sufficient, while 42% rated it somewhat or very insufficient. A near-even split on whether teams have the capacity to do the work.
- 45% of clinics don’t measure their remote monitoring program performance in any structured way. Of those that do, only 29% track quality-related metrics. Most are counting workload volume.
The three tasks respondents identified as most burdensome — and the ones they were most willing to outsource — were managing disconnected patients, initial transmission review, and patient phone calls.
Where the Gap Shows Up
Awareness of best practices doesn’t translate cleanly to consistent adoption. Most clinics know what the guidelines say. The execution varies for reasons that are mostly operational rather than clinical.
Reimbursement is part of it. In the United States, scheduled transmission frequency aligns with reimbursement rules: monthly for ICMs, quarterly for therapeutic devices. In Europe, where remote monitoring often lacks clear funding, practice is more variable. The system pays for what it values, and clinics tend to follow.
Staffing is another. The 43/42 split on staffing sufficiency is one of the more telling numbers in the data. A clinic can know exactly what it should be doing and still not have the hours in the day to do it. That isn’t a knowledge problem. It’s a capacity problem.
The third factor is measurement. Nearly half of clinics don’t measure their remote monitoring program performance at all. Of the clinics that do measure, most are counting transmissions reviewed rather than tracking whether those reviews caught what mattered. You can’t optimize what you don’t measure.
Is This a Technology Problem or an Operations Problem?
This is an operations problem, not a technology problem.
The platforms work. The clinical guidance exists. What’s missing in most clinics isn’t tooling. It’s a consistent operational layer underneath the technology: workflows that scale, alert protocols that reduce non-actionable burden without missing what’s clinically meaningful, staffing models that match the actual workload, and performance measurement that goes beyond transmission counts.
We addressed the alert protocol piece of this in a separate study published in the Journal of Cardiovascular Electrophysiology, which showed that guideline-based reprogramming can reduce non-actionable alerts by 74% without increasing adverse outcomes. That kind of intervention is one part of the operational layer this international survey is describing the absence of.
Why This Matters Now
The number of patients living with cardiac devices keeps growing. So does the volume of data those devices generate. So do clinical expectations for proactive, between-visit care.
A device clinic running on default workflows and individual heroics will absorb that growth for a while. Eventually, it doesn’t.
When the operational layer doesn’t keep up, clinicians get overwhelmed and burnout climbs. Real signals get harder to find inside the noise. The clinical value remote monitoring is supposed to deliver doesn’t get delivered. That’s the gap.
What Closing the Gap Actually Looks Like
A few things, in order of leverage.
Standardized workflows for the operational tasks that consume the most time. Disconnected patients. Initial transmission review. Patient phone calls. These were the three areas the survey identified as most burdensome — and the three respondents were most ready to outsource. They are also the three most amenable to standardization.
Alert protocols tied to clinical context, not manufacturer defaults. The reprogramming evidence is strong enough now to justify ongoing protocol review as a clinic-level function, not an individual one.
Capacity that matches the work, not the org chart. The near-even split on staffing sufficiency is the clearest signal in the survey that current models aren’t sustainable. That’s a leadership-level conversation, not a workflow tweak.
Performance measurement that tracks quality, not just volume. If 45% of clinics aren’t measuring at all and most of the rest are counting transmissions, the field doesn’t have a baseline to improve from. Build that first.
Closing the Gap
Remote monitoring has changed what’s possible in device care. The next step is making sure it works the way it’s designed to. That means building the operational layer underneath, not adding more tools on top.
The technology is here. The guidelines are here. The gap is in execution.
Study citation: Allred J, Seiler A, Lyons M, Roberts P, Tsiperfal A, van Heel L, Meijer C, Nicolle E, Lanctin D, Martens E. Current practices in managing patients with cardiac implantable electronic devices: Results of an international survey. Heart Rhythm O2. 2025;6(6):781-788. doi: 10.1016/j.hroo.2025.02.019.
Read the full open-access study →
If your device clinic is feeling the gap between what guidelines recommend and what your team has the capacity to deliver, CV Remote Solutions can help. We work with clinics to standardize workflows, optimize alert programming, and build the operational layer that makes remote monitoring sustainable. Schedule a consultation with a clinician.