# Patient-initiated transmissions in remote monitoring of cardiac implantable electronic devices: Evaluating volume, clinical value, and short message service-based strategy to reduce unnecessary transmissions

## TL;DR

This study shows that many patient-initiated remote monitoring transmissions for heart devices are unnecessary and can be reduced with a simple SMS strategy.

## Contribution

A novel SMS-based strategy is introduced to reduce nonactionable patient-initiated transmissions in cardiac device monitoring.

## Key findings

- Most patient-initiated transmissions (85%) were clinically nonactionable.
- An SMS intervention reduced asymptomatic transmissions by 31.2%.
- Only 3.6% of transmissions led to in-office visits.

## Abstract

Remote monitoring (RM) has been shown to improve clinical outcomes compared with traditional in-office follow-up and has seen rapid adoption. However, most RM transmissions are nonactionable, contributing to clinical workload. Many cardiac implantable electronic devices (CIEDs) allow patient-initiated transmissions, which are frequently nonactionable. More efficient strategies are needed to manage this burden without compromising patient safety.

This study aimed to describe the reasons behind patient-initiated transmissions in RM of CIEDs and assess the impact of a simple short message service (SMS)-based intervention to reduce unnecessary transmissions.

At Helsinki University Hospital in 2024, each RM transmission was evaluated for its cause and resulting clinical action. Patient-initiated transmissions were analyzed for indications and outcomes. Beginning in June 2024, patients who sent transmissions without a clear medical reason received an SMS explaining RM procedures and device functionality. The effect of this intervention on transmission volume was measured.

4020 CIEDs produced 8182 RM transmissions. Of the 8182 transmissions, 2268 (27.7%) were patient initiated, with an average of 0.049 transmissions per device per month. Among 1234 transmissions triggered by symptoms or unknown reasons, 85.0% were clinically nonactionable. Only 3.6% led to an in-office visit. After implementing the SMS intervention, the frequency of asymptomatic patient-initiated transmissions decreased by 31.2% (P = .008).

Patient-initiated transmissions significantly contribute to RM workload, although most do not lead to clinical action. A simple SMS-based strategy effectively reduced nonactionable transmissions, enhancing the efficiency of RM workflows.