Outcomes associated with remote monitoring without in-person evaluations for patients with cardiovascular implantable electronic devices.

Background: Traditionally, patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) attend routine in-person evaluations at least annually, paired with remote monitoring (RM). Because similar data can be obtained through RM and in-person evaluations, it is unclear whether routine in-person evaluations are necessary. Objective: This study aimed to compare major adverse cardiac events (MACE) in patients who did vs did not receive in-person CIED care while participating in RM. Methods: We classified patients who received their CIED care within the Veterans Health Administration and sent ≥1 RM transmission between July 1, 2020, and June 30, 2021, into 2 groups based on clinician evaluation type for their CIED care: (1) at least 1 in-person evaluation or (2) remote-only evaluations. The primary outcome was MACE, a composite of all-cause mortality, stroke, and cardiac hospitalization, in the following year (July 1, 2021, to June 30, 2022). We performed multivariable logistic regression, adjusting for patient- and device-related characteristics. Results: Of 40,367 patients, 38,213 (94.7%) had at least 1 in-person evaluation for CIED care. The mean patient age was 72.8 years and 97.4% were male. There were 11,248 total MACEs (27.9%), 10,777 (28.2%) among patients who had at least 1 in-person evaluation and 471 (21.9%) among those with remote-only evaluations for CIED care. After multivariable adjustment, there was no significant difference in MACE (odds ratio 1.11; 95% confidence interval 0.98-1.25) between patients who had any in-person evaluation and those who had remote-only evaluations for CIED care. Conclusion: Among patients engaged in RM, the odds of MACE were similar regardless of whether patients had any in-person evaluations vs remote-only evaluations for CIED care.