Patient and Provider Perspectives on Remote Monitoring of Pacemakers and Implantable Cardioverter-Defibrillators.

The use of remote monitoring technology for cardiovascular electronic implantable devices has grown significantly in recent decades, yet several key questions about its integration into clinical care remain. We performed semi-structured interviews of patients, clinicians, and device clinic technicians involved in clinical remote monitoring of cardiovascular implantable devices at our institution. Twenty-eight interviews comprised of 15 patients and 13 clinicians were conducted from October 2019 through February 2020. Interview transcripts were analyzed using a mixed inductive and deductive approach. Perspectives among clinicians and patients varied regarding familiarity, educational experiences, and preferences regarding how remote monitoring data are handled. Three key domains emerged including knowledge and understanding, managing alerts, and cost transparency. Within these domains, key findings included identifying very limited understanding of how remote monitoring functions and how alerts in particular are handled. These knowledge deficits (patients and providers) appeared to arise in part from different equipment and platforms among manufacturers, the complexity of the technology, and lack of formalized education in remote monitoring. However, interviewees expressed generally high levels of trust in the technology and care systems supporting remote monitoring. Few respondents described concerns around cybersecurity, but patients in particular did raise concerns about cost transparency and frequent billing. In conclusion, conflicting perceptions around remote monitoring persist and indicate important knowledge gaps despite high trust in the care pathway. This qualitative analysis offers insight into patient and clinician understanding of and attitudes toward remote monitoring to guide future efforts to improve education and patient-centeredness of remote monitoring.

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Authors: Ariane M Fraiche, Daniel D Matlock, Wilanda Gabriel, Faith-Anne Rapley, Daniel B Kramer