Authors

• Ivica Benko — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0002-1878-0880
• Ivona Filipović — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0009-0000-7291-6219
• Magdalena Drljačić — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0009-0004-8530-9230
• Mateja Lovrić — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0003-1457-6521
• Marina Žanić — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0001-5123-8586
• Marina Budetić — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0002-1165-7097
• Nikolina Slamek — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0002-2975-8793
• Mirela Adamović — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0003-4922-7436
• Marija Grlić — Dubrava University Hospital, Zagreb, Croatia — ORCID: 0000-0002-4288-9659

Keywords

remote monitoring, cardiac implantable electronic devices, nurse led model, implementation

DOI

Full Text

**Introduction**: Remote monitoring (RM) of cardiac implantable electronic devices shortens time to clinical decision from 22 to 4.6 days and reduces cardiovascular hospital stay from 4.0 to 3.3 days (1). RM can reduce in-hospital device evaluations by about 45% and detect clinically relevant events within less than 2 days (2). Network-based follow-up has been associated with improved survival compared with clinic-only care (3). We describe organizational challenges in introducing RM and early outcomes from a high-voltage (HV) device cohort. **Patients and Methods:** This was a single-center implementation integrating RM into routine workflow. A nurse-led coordination model was created with triage protocols, escalation pathways, electronic medical records templates, informed consent and General Data Protection Regulation-compliant data handling. The first 14 implantable cardioverter-defibrillator (ICD) / cardiac resynchronization therapy defibrillator patients were enrolled over four months. Alerts were reviewed on working days with predefined thresholds for intervention or recall. **Results:** Within the first four months, two device-related interventions were performed based on RM alerts and two patients were urgently recalled. One patient with heart failure presented with a new arrhythmia, and another experienced appropriate ICD therapy. No adverse events were linked to RM processes. Specially trained nurses managed alert handling and documentation with electrophysiology oversight. **Conclusion:** A structured nurse-led RM program for HV devices is feasible and safe, translating literature-proven benefits into clinical practice. Specially educated nurses can reliably manage daily RM operations, ensuring timely interventions and reduced outpatient load. Broader adoption requires formal education pathways, certification by professional societies and clear administrative and legal governance.

Literature

1. Crossley GH, Boyle A, Vitense H, Chang Y, Mead RH. CONNECT Investigators. The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial: the value of wireless remote monitoring with automatic clinician alerts. J Am Coll Cardiol. 2011 March 8;57(10):1181–9. https://doi.org/10.1016/j.jacc.2010.12.012
2. Varma N, Epstein AE, Irimpen A, Schweikert R, Love C. TRUST Investigators. Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation. 2010 July 27;122(4):325–32. https://doi.org/10.1161/CIRCULATIONAHA.110.937409
3. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, et al. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: the ALTITUDE survival study. Circulation. 2010 December 7;122(23):2359–67. https://doi.org/10.1161/CIRCULATIONAHA.110.960633