Optimising Management of Cardiac Implantable Electronic Device Remote Monitoring Through Digital Health Initiatives

Abstract

Introduction

Cardiac Implantable Electronic Device (CIEDs) remote monitoring (RM) was introduced to streamline in clinic workflows but has since shown substantial patient and system benefits. However, unscheduled RM alerts increase clinician workload, and limited guidance affects decision making. Patients also want greater engagement, yet current practices restrict this. This thesis advances understanding and implementation of effective CIED RM models.

Methods

This thesis examined CIED RM use across Australia and New Zealand, stakeholder perspectives, and the feasibility of digital support interventions. Methods included mixed methods analysis of industry and clinic data; interviews exploring RM barriers and enablers; observational and implementation evaluations of SMS based support programs; a randomised controlled trial of a post implant support program (PARTICIPATE); and development of expert consensus recommendations using a modified Delphi process.

Results

Findings showed a 10.2% rise in CIED implantations and a 55.8% increase in RM distribution from 2019–2023. Interviews with 35 stakeholders highlighted major implementation barriers, including limited resources, lack of standardised guidance, inadequate post implant education, and minimal patient engagement. The HeartHealth program reduced healthcare utilisation (RR 0.91) and was well accepted, with high completion and positive behavioural impacts. Preliminary PARTICIPATE trial findings showed high satisfaction with post implant support. A Delphi process produced 23 expert recommendations for RM data management and clinical response.

Conclusion

This thesis shows that optimising CIED RM requires digital health tools and standardised data management. SMS based programs improved engagement, support, and outcomes, while expert recommendations strengthened workflows. Together, these findings inform future CIED RM policy, reimbursement, and the transition from remote monitoring to comprehensive remote management.