Cardiac implantable electronic device patient follow-up: Assessment of U.S. practice.

BACKGROUND

A 2015 expert consensus statement recommended that patients with cardiac implantable electronic devices receive remote monitoring and at least 1 in-office evaluation annually.

OBJECTIVE

The purpose of this study was to examine whether patients who underwent implantation of a new cardiac implantable electronic device received care concordant with consensus statement recommendations.

METHODS

We examined the rate of follow-up office visits and remote monitoring for 211,346 Medicare beneficiaries with an implantation of a new cardiac implantable electronic device between October 2015 and December 2020. We also assessed the characteristics of patients receiving follow-up care.

RESULTS

Within 16 weeks of implantation 77.8% of patients were seen in-office for a postoperative evaluation. The percentage of patients seen in office was 85.9% in the first 12 months, with 64.2% of patients seen in office every 2 years postimplantation, respectively. Following implantation, the percentage of beneficiaries receiving remote monitoring in the first 91 days was 14.7%, with 4.4% patients receiving remote monitoring every 91 days postimplantation within the first year. Patients who were ≥85 years old, nonwhite, or of lower income were less likely to receive office visits postimplantation.

CONCLUSIONS

Although most Medicare beneficiaries were seen in-office in the year following a new implant, the percentage of beneficiaries with an in-office visit declined in subsequent years. Fewer than 5% of beneficiaries had remote monitoring at the frequency recommended by the expert consensus statement. Patient demographics, including older age, nonwhite race, and lower income were associated with a lower likelihood of receiving care concordant with consensus statement recommendations.