Remote Patient Management for Cardiac Implantable Electronic Devices
Remote Patient Management for Cardiac Implantable Electronic Devices
This is a pilot study to assess barriers, evaluate and implement a patient oriented CIED
 management model incorporating advanced technological innovation to promote a paradigm shift
 to patient-centered care involving remote CIED monitoring and programming. The advancement in
 technology is very important as it addresses several potential gaps and barriers in the care
 of patients with CIEDS:

 1. Long, expensive travel for patients

 2. Morbidity to patients due to delay in receiving appropriate treatment

 3. Efficiency in health care delivery

 4. Patient satisfaction
Canada is a country with a diverse geography, of which 19% of the inhabitants are in
 communities classified as 'rural', but many may still have long distances to travel to reach
 a health care facility. This results in challenges in uniform delivery of health care
 throughout the country. There are 25,000 pacemaker (PM) implants and 7000 implantable
 defibrillator (ICD) implants yearly in Canada, with approximately 120 000 patients living
 with these devices. The recommended follow-up for these devices are based on consensus and
 position statements, with the majority of patients requiring at least yearly visits to a
 specialized device clinic during the lifetime of their device. During the life of these
 patients, many issues may arise, such as atrial or ventricular arrhythmias that may result in
 syncope, stroke or sudden death, need for increased monitoring resulting from device
 advisories, or minor programming adjustments to improve device performance, or simply the
 need for enhanced surveillance as the device battery depletes and replacement is anticipated.

 While remote monitoring technology is currently available and has permitted surveillance and
 device assessment from any patient location accessible to a landline or mobile phone, the use
 has been inconsistent in Canada. In addition, new technology has become available that not
 only permits surveillance, but also remote programming of these devices. The incorporation of
 remote programming capability, along with automatic recalibration of device settings, allows
 us to develop a new paradigm of remote patient management where after the patient receives
 their device, they would remain in the care of their local health team and no longer require
 travel to the specialized 'hub' clinics for follow-up.
Inclusion Criteria:

 1. Patients with an implanted pacemaker/cardiac resynchronization therapy with a
 pacemaker(CRT-P) capable of remote patient management would be eligible for the study
 that will be followed by the site where the implantation occurred OR patients with an
 implanted defibrillator/CRT-D capable of remote patient management where the patients
 reside in a community OUTSIDE of the site where the implantation occurred. The device
 may be de novo, existing or a patient undergoing a pulse generator change that now has
 remote patient management capabilities.

 2. Able to provide consent.