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

Reviewing current services

Before introduction of the project, people with heart failure (HF) with Medtronic devices were jointly managed by the device team and the acute or community HF teams. There was no structured pathway and often work was duplicated by the device and HF teams, causing confusion. Often heart failure related device alerts were not dealt with in a timely manner and resulted in hospital admissions. Pre-audit data November to December 2022 revealed there were a 17 patient device alerts for a total of 6 patients. Of these 3 patients there were 3 hospital admissions with heart failure. Based on the 2021/2022 tariff this is a potential cost saving of £9,645.

Implementation

The HF team took over the heart failure-related device alerts on carelink in June 2023. These alerts included OptiVol rise with reduced impedance, reduced activity. All alerts regarding arrhythmias continued to be managed by the cardiac physiologists.

All acute HF nurses were trained on using carelink and given access to the carelink system. Initially we accessed carelink twice a week and looked at the medium and high-risk alerts. Any patients were added to a remote walk-in clinic to capture the patient contacts. Patients were called to assess symptoms. If asymptomatic they were safety netted with contact numbers in case of future decompensation and a download rescheduled for 2 to 3 weeks. People with symptoms were booked for an urgent review in an acute of community HF clinic. Any unresolved issues were discussed at the advanced HF multidisciplinary team that is held weekly.