Why the study?
Although a 2023 international consensus provides recommendations on managing remote CIED clinics, the adoption of these practices in real-world practice is unknown.
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This international survey reveals substantial real-world variability and gaps in implementing the 2023 HRS/EHRA/APHRS/LAHRS remote device clinic consensus recommendations, particularly regarding the overuse of annual routine in-office visits and regional disparities in remote monitoring adoption between the US and Europe.
Background: Managing patients with cardiac implantable electronic devices (CIEDs) is increasingly complicated with expanding populations and evolving technologies. While the 2023 Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society consensus on management of remote device clinics provides recommendations, the adoption of these practices in real-world practice is unknown. Objective: This survey of device clinic staff characterized the adoption and variability of CIED follow-up practices. Methods: A Delphi panel composed of U.S. and European Union clinical experts guided the research objectives, structure, and content of the survey. Once consensus was reached, the online survey (Qualtrics) was deployed in partnership with HRS through e-mail, social media posts, and at the HRX conference. An available case analysis was performed to handle missing data. Results: A total of 471 responses were collected from 44 countries, including 310 in the United States, 88 in Europe, and 73 in other regions. Broad representation was achieved with respect to staff role, years of experience, and clinic ownership. Most (71%) respondents reported being aware of the 2023 consensus statement. While the majority (77%-83%, depending on device type) reported using hybrid in-person and remote management for patients with therapeutic CIEDs, 89% to 91% reported scheduling routine office visits at least once per year, depending on device type, respectively. Only 50% of respondents reported a hybrid approach for insertable cardiac monitor patients, with 35% reporting remote-only follow-up. Conclusion: Variable adoption was found for many practices recommended in the 2023 Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society consensus. Future research should focus on optimal implementation of recommended practices.
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Allred et al. (2025) studied this question.
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