Barriers To Remote Monitoring In Patients With Implantable Cardioverter Defibrillators

Background: Remote monitors are machines that allow patients with implantable cardioverter-defibrillators (ICDs) to transtelephonically send data to their physicians. Remote monitors have been associated with increased survival and faster recognition of clinical events. Despite the benefits of using remote monitors, they are highly underused. We aimed to better understand barriers to the usage of remote monitors. Methods: Mixed methods interview was used,with both quantitative questions and qualitative in-depth interview. Patients who had Medtronic ICDs placed at either Yale Electrophysiology or Cardiology Associates of New Haven were invited to participate. 82 patients consented to participate. Results: Quantitative data showed that compared to people who do not use remote monitors, people who transmit are more likely to own a landline, use computers regularly, have non-government health insurance, and believe there is a benefit to using the monitor. Qualitative data showed that there are several categories of reasons that patient do not use remote monitors including a belief that transmissions are being sent, a belief that there is no benefit to monitoring, problems with set up, problems with phone lines, financial limitations, and low strength of physician recommendation. Conclusions: This study has identified several potential barriers to remote monitoring that should be confirmed with quantitative methods. To increase remote monitor usage, physicians ought to educate patients about the benefits of monitoring and explicitly recommend the use of monitors. In addition, device manufacturers should provide feedback from monitors and consider ways to make monitoring more accessible to patients, both financially and technologically