Heart failure algorithms for remote monitoring in people with cardiac implantable electronic devices

Outcomes

Audit data from November 2023 showed a marked increase in alerts, which were mostly unscheduled. There were a total of 98 alerts (compared with 21 alerts in August and 11 alerts in June).

Heart failure (HF) admissions: 0

Non-HF admissions: 2

Acute HF nurse review: 1

Community HF nurse review: 11

Electrophysiology multidisciplinary team or cardiac physiologists: 2

No action required: 82

Currently total of 512 patients on HF carelink caseload.

The interventions listed above have involved reviewing patients and prevented further decompensation. There have only been 3 heart failure admissions in June to December 2023 (further audit data for 2024 is to be calculated).

Learning

1. Significant number of unscheduled downloads by patients - working alongside the device team and Medtronic patient letters are sent out to advise not to send in remote downloads, which has reduced the number we get.

2. Time consuming for staff with little yield - so we now only review high-risk alerts twice a week. This has been added to our weekly task list and allocated for 1 member of staff to do each week.

3. Duplication of work - those seen in device clinic will still alert on HF clinic on carelink. The HF team document on carelink if a patient has been contacted. The device team are emailed for any patients that have both HF-related risk and arrhythmia. All arrhythmia alerts are handled by the device team.

4. Most patients are already known to the community teams so we refer directly to the team if there is a patient alert and they are under them.