Octagos Innovation Catalyst Report: Laundry That Never Stops-Octagos Innovation Catalyst Report (PDF)

Octagos Innovation Catalyst Report (PDF)

Pdf Summary

Remote monitoring of cardiac implantable electronic devices (CIEDs) has become a Class I–endorsed standard of care, shifting follow-up from episodic visits to continuous surveillance. However, this operational study—based on four focus groups with 37 allied health professionals (AHPs) from 30 diverse practices and a follow-up survey—finds that workflows, staffing, and standards have not kept pace with rapid growth, especially the expansion of implantable loop recorders and the resulting surge in scheduled and unscheduled transmissions.<br /><br />AHPs reported that alert volume is the dominant driver of workload, often described as “laundry that never stops,” with a small subset of “frequent flyer” patients generating disproportionate noise. Programs use dynamic alert programming and tiered triage to reduce non-actionable data, but uncertainty around thresholds for device-detected atrial fibrillation, nonsustained ventricular tachycardia, and pauses creates anxiety about missed events and medico-legal exposure. Staffing benchmarks (e.g., ~3 FTE per 1,000 patients) are viewed as incomplete because they do not specify role mix or account for workload complexity, third-party partners, or the large amount of non-billable connectivity work.<br /><br />Connectivity management (“chasing unplugged boxes”) is labor-intensive and complicated by socioeconomic barriers, creating ethical tension around “discharging” persistently disconnected patients. Documentation and billing requirements are seen as burdensome and misaligned with clinical value, while patient affordability concerns can drive dissatisfaction. Heart failure (HF) device diagnostics are considered valuable but often lack clear ownership between electrophysiology (EP) and HF teams, including ambiguity about workflows and billing.<br /><br />AHPs called on the Heart Rhythm Society (HRS) to provide: role-specific staffing models; standardized, defensible alert programming/triage guidance; patient- and administrator-facing resources (education, agreements, economic models); advocacy for greater manufacturer standardization; and joint EP–HF guidance for HF monitoring. The report also notes third-party platforms and supervised, human-in-the-loop AI as potential “force multipliers,” while emphasizing minimum safety/coverage standards and clinical accountability.

Keywords

remote monitoring

cardiac implantable electronic devices

CIED workflows

alert fatigue

implantable loop recorders

tiered triage

atrial fibrillation detection thresholds

connectivity management

staffing benchmarks FTE

Heart Rhythm Society guidance