Barriers and Facilitators Associated with Remote Monitoring Adherence among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators
ABSTRACT
Background:
The Heart Rhythm Society strongly recommends remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) because of clinical outcome benefits to patients. However, many patients do not adhere to RM.
Objective:
We sought to identify barriers and facilitators associated with adherence to RM among Veterans with CIEDs followed by the Veterans Health Administration.
Methods:
We interviewed 40 Veterans with CIEDs regarding their experiences of RM. Patients were stratified into three groups based on their adherence to scheduled RM transmissions over the past 2 years: 6 fully adherent (≥95%), 25 partially adherent (≥65% but <95%), and 9 non-adherent (<65%). Interviews focused on 4 domains: knowledge of RM, satisfaction with RM, reasons for non-adherence, and preferences for healthcare engagement.
Results:
Mean (SD) patient age was 75.3 (7.6) years and 39 (98%) were men. patients had been implanted with their current CIED for an average 4.6 (SD 2.9) years. Forty-five percent of patients reported good understanding of RM; however, when asked to describe RM, their understanding was sometimes incomplete and/or not correct. Among the 31 fully or partially adherent patients, nearly all were satisfied with RM. Approximately one-third recalled ever being told the results of a remote transmission. Among patients who were partially or non-adherent, only one-fourth reported being contacted by a VA healthcare professional regarding not having sent a remote transmission; among those who had troubleshooted to ensure they could send remote transmissions, they often relied on the CIED manufacturer for help, and this experience was nearly always positive. Most non-adherent patients felt that they would be more comfortable engaging in RM if they received more information or education. Most patients were interested in being notified that a remote transmission had been successful transmissions and learning the results of their remote transmissions.
Conclusions:
Veterans with CIEDs often had limited knowledge about remote monitoring, although they were satisfied with the process. These findings provide opportunities to optimize strategies for educating and engaging patients in remote monitoring. Clinical Trial: NA
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