Utilization and implementation of remote monitoring of cardiac implantable electronic devices in Australia and New Zealand: Adoption, workload, and integration challenges

Background Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) reduces healthcare visits and improves clinical outcomes, but its use and service models are poorly characterised. Objectives To examine the current landscape of CIED RM in Australia and New Zealand, including the prevalence of CIED and RM use, care models for RM data management, and infrastructure and resource requirements. Methods A cross-sectional study was conducted using surveys of CIED clinics in Australia and New Zealand and analysis of de-identified CIED industry data. Data were obtained from public and private clinics and all five major CIED manufacturers. Results Operational data were obtained from 50 clinics and implant/RM distribution data from all five manufacturers. From 2019 to 2023, total CIED implantations increased by 10.2% (125.9 to 138.8 per 100,000 people), while RM transmitter distribution rose 55.8% (75.5 to 117.6 per 100,000 people). In 2023, RM use was highest in remote (88.4%) and rural (85.3%) regions compared with regional (73.1%) and metropolitan (80.3%) areas. From survey data, the median clinic patient load was 1,303 patients (IQR 1,820) per year. On average, 30.2% (SD 21.8%) of clinic workload was dedicated to managing RM alerts, primarily by cardiac physiologists (90.5%). The mean interval between scheduled in-person CIED follow-ups was longer for RM patients compared to non-RM patients (10.0 vs 7.2 months, p<0.001). Conclusion This study provides the first comprehensive analysis of CIED RM service use, offering insights to inform future RM care models and the development of other virtual care systems using remote patient data.