title: Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association.
abstract: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) permits early detection of arrhythmias, device, and lead failure and may also be useful in risk-predicting patient-related outcomes. Financial benefits for patients and healthcare organizations have also been shown. We sought to assess the implementation and funding of RM of CIEDs, including conventional pacemakers (PMs), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices in Europe. Electronic survey from 43 centres in 15 European countries. In the study sample, RM was available in 22% of PM patients, 74% of ICD patients, and 69% of CRT patients. The most significant perceived benefits were the early detection of atrial arrhythmias in pacemaker patients, lead failure in ICD patients, and worsening heart failure in CRT patients. Remote monitoring was reported to lead a reduction of in-office follow-ups for all devices. The most important reported barrier to the implementation of RM for all CIEDs was lack of reimbursement (80% of centres). Physicians regard RM of CIEDs as a clinically useful technology that affords significant benefits for patients and healthcare organizations. Remote monitoring, however, is perceived as increasing workload. Reimbursement for RM is generally perceived as a major barrier to implementation.
authors.affiliation: Cliniques du Sud Luxembourg, Arlon, Belgium.
authors.forename: Georges H
authors.initials: GH
authors.lastname: Mairesse
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Frieder
authors.initials: F
authors.lastname: Braunschweig
authors.affiliation: IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Klersy
authors.affiliation: Imperial College London (Royal Brompton Hospital), London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Aston University Medical School, Queen Elizabeth Hospital, Birmingham, UK cardiologists@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D042241:Early Diagnosis; D004554:Electric Countershock / Q000191:economics* / Q000295:instrumentation; D005060:Europe; D017048:Health Care Costs; D019538:Health Care Surveys; D006331:Heart Diseases / Q000175:diagnosis / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D058998:Remote Sensing Technology / Q000191:economics*; D012815:Signal Processing, Computer-Assisted; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Heart failure; Implantable cardioverter defibrillator; Pacemaker; Remote monitoring; Telemonitoring