{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:18:45Z","timestamp":1789049925271,"version":"build-2803163510"},"reference-count":32,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cardio"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Patients with cardiovascular implantable electronic devices (CIEDs) typically attend in-person CIED clinic visits at least annually, paired with remote monitoring (RM). As the CIED data available through in-person CIED clinic visits and RM are nearly identical, the 2023 Heart Rhythm Society expert consensus statement introduced \u201calert-based RM,\u201d an RM-first approach where patients with CIEDs that are consistently and continuously connected to RM, in the absence of recent alerts and other cardiac comorbidities, could attend in-person CIED clinic visits every 24 months or ultimately only as clinically prompted by actionable events identified on RM. However, there is no published information about patient and clinician perspectives on barriers and facilitators to such an RM-first care model.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to understand patient and clinician perspectives about an RM-first care model for CIED care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We interviewed 40 rural veteran patients who were experienced with RM with CIEDs and 22 CIED clinicians who were experienced in using RM regarding barriers and facilitators to an RM-first care model. We conducted a reflexive thematic analysis of interviews. Two authors familiarized themselves with the dataset and generated separate codebooks based on the interview guides and inductively coded notes. These 2 authors met and reviewed each other\u2019s codes, sought additional author input, and resolved differences before 1 author coded the remaining interviews and developed candidate themes. These themes were refined, named, and supported with quotations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Patients expressed interest in an RM-first approach, to reduce the burden of long travel times, sometimes in inclement weather, and to enable clinicians to provide care for other patients. However, many preferred routine in-person visits; reasons included a skepticism of the capabilities of RM, a sense that in-person visits provided superior care, and enjoyment of in-person patient-clinician relationships. Clinicians were interested in RM-first care, especially for stable, RM-adherent patients who were not device-dependent. Clinicians most frequently cited the benefit of reducing patient travel burden as well as optimizing clinic space and time to focus on other care such as reviewing routine RM transmissions, but also noted barriers including lack of in-person assessment, patient-perceived diminution of the patient-clinician relationship, possible loss to follow-up, and technological difficulties. Clinicians felt that an RM-first care model should be evaluated for success based on patient satisfaction and assessment of timely addressing of rhythm issues to prevent adverse outcomes. Most clinicians believed that RM-first care represented the future of CIED care.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Both patients and CIED clinicians interviewed who were experienced in using RM were open to an RM-first care model that reduces in-person visits but reported some barriers to solely relying on RM and possible diminution of the patient-clinician relationship. Implementation of new RM recommendations will require attention to these perceptions and prioritization of patient-centered approaches.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/66215","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T15:54:54Z","timestamp":1743782094000},"page":"e66215-e66215","source":"Crossref","is-referenced-by-count":7,"title":["Patient and Clinician Perspectives on Alert-Based Remote Monitoring\u2013First Care for Cardiovascular Implantable Electronic Devices: Semistructured Interview Study Within the Veterans Health Administration"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-0693","authenticated-orcid":false,"given":"Allison","family":"Kratka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4852-2188","authenticated-orcid":false,"given":"Thomas L","family":"Rotering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5048-067X","authenticated-orcid":false,"given":"Scott","family":"Munson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5638-7732","authenticated-orcid":false,"given":"Merritt H","family":"Raitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5943-0078","authenticated-orcid":false,"given":"Mary A","family":"Whooley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":false,"given":"Sanket","family":"S Dhruva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","first-page":"e69","DOI":"10.1016\/j.hrthm.2015.05.008","article-title":"HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices","volume":"12","author":"Slotwiner","journal-title":"Heart Rhythm"},{"issue":"9","key":"R2","doi-asserted-by":"publisher","first-page":"e92","DOI":"10.1016\/j.hrthm.2023.03.1525","article-title":"2023 HRS\/EHRA\/APHRS\/LAHRS expert consensus statement on practical management of the remote device clinic","volume":"20","author":"Ferrick","journal-title":"Heart Rhythm"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1161\/CIRCEP.114.003030","article-title":"Use of remote monitoring is associated with lower risk of adverse outcomes among patients with implanted cardiac defibrillators","volume":"8","author":"Akar","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"24","key":"R4","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1016\/j.jacc.2015.04.033","article-title":"The relationship between level of adherence to automatic wireless remote monitoring and survival in pacemaker and defibrillator patients","volume":"65","author":"Varma","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s10840-016-0112-y","article-title":"Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation","volume":"46","author":"Mittal","journal-title":"J Interv Card Electrophysiol"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1016\/j.hrthm.2016.08.024","article-title":"Impact of remote monitoring on clinical events and associated health care utilization: a nationwide assessment","volume":"13","author":"Piccini","journal-title":"Heart Rhythm"},{"issue":"8","key":"R7","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1093\/eurheartj\/ehs425","article-title":"A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial","volume":"34","author":"Gu\u00e9don-Moreau","journal-title":"Eur Heart J"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/pace.13574","article-title":"Remote monitoring of implantable cardioverter defibrillators: patient experiences and preferences for follow-up","volume":"42","author":"Timmermans","journal-title":"Pacing Clin Electrophysiol"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"32342703","DOI":"10.1161\/CIRCEP.119.007734","article-title":"Remote management of pacemaker patients with biennial in-clinic evaluation: continuous home monitoring in the japanese at-home study: a randomized clinical trial","volume":"13","author":"Watanabe","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"23","key":"R10","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1093\/eurheartj\/ehz067","article-title":"Safety and efficiency of a common and simplified protocol for pacemaker and defibrillator surveillance based on remote monitoring only: a long-term randomized trial (RM-ALONE)","volume":"40","author":"Garc\u00eda-Fern\u00e1ndez","journal-title":"Eur Heart J"},{"issue":"8","key":"R11","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1016\/j.jacep.2021.01.008","article-title":"Alert-based ICD follow-up: a model of digitally driven remote patient monitoring","volume":"7","author":"Varma","journal-title":"JACC Clin Electrophysiol"},{"issue":"9","key":"R12","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1016\/j.hrthm.2022.04.025","article-title":"Factors associated with remote monitoring adherence for cardiovascular implantable electronic devices","volume":"19","author":"Muniyappa","journal-title":"Heart Rhythm"},{"key":"R13","unstructured":"Office of Rural Health. Rural Veterans. US Department of Veterans Affairs. URL: https:\/\/www.ruralhealth.va.gov\/aboutus\/ruralvets.asp [Accessed 19-03-2025]"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","journal-title":"Implement Sci"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/50973","article-title":"Barriers and facilitators associated with remote monitoring adherence among veterans with pacemakers and implantable cardioverter-defibrillators: qualitative cross-sectional study","volume":"7","author":"Dhruva","journal-title":"JMIR Cardio"},{"issue":"12","key":"R16","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1016\/j.hroo.2023.11.002","article-title":"Strategies to enhance remote monitoring adherence among patients with cardiovascular implantable electronic devices","volume":"4","author":"Rotering","journal-title":"Heart Rhythm O2"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","article-title":"Toward good practice in thematic analysis: avoiding common problems and be(com)ing a researcher","volume":"24","author":"Braun","journal-title":"Int J Transgend Health"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"Saunders","journal-title":"Qual Quant"},{"issue":"114523","key":"R20","doi-asserted-by":"publisher","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: a systematic review of empirical tests","volume":"292","author":"Hennink","journal-title":"Soc Sci Med"},{"issue":"12","key":"R21","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1258\/jrsm.2011.110180","article-title":"The answer is 17 years, what is the question: understanding time lags in translational research","volume":"104","author":"Morris","journal-title":"J R Soc Med"},{"issue":"9","key":"R22","doi-asserted-by":"publisher","first-page":"825","DOI":"10.7326\/0003-4819-135-9-200111060-00012","article-title":"Clinical inertia","volume":"135","author":"Phillips","journal-title":"Ann Intern Med"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.hroo.2021.12.002","article-title":"Challenges in managing a remote monitoring device clinic","volume":"3","author":"Harvey","journal-title":"Heart Rhythm O2"},{"issue":"Suppl 1","key":"R24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s11606-023-08478-9","article-title":"Informational postcards increase engagement with remote monitoring among veterans with pacemakers and implantable cardioverter-defibrillators: a stepped-wedge randomized controlled trial","volume":"39","author":"McLaughlin","journal-title":"J Gen Intern Med"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cvdhj.2023.11.020","article-title":"Using technology to improve reconnection to remote monitoring in cardiac implantable electronic device patients","volume":"5","author":"Durand","journal-title":"Cardiovasc Digit Health J"},{"issue":"5","key":"R26","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.jacc.2023.11.024","article-title":"Promises and perils of consumer mobile technologies in cardiovascular care: JACC scientific statement","volume":"83","author":"Varma","journal-title":"J Am Coll Cardiol"},{"issue":"Suppl 1","key":"R27","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1007\/s11606-023-08475-y","article-title":"Disparities in video-based primary care use among veterans with cardiovascular disease","volume":"39","author":"Tisdale","journal-title":"J Gen Intern Med"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1093\/jamiaopen\/ooz024","article-title":"Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans","volume":"2","author":"Zulman","journal-title":"JAMIA Open"},{"issue":"4","key":"R29","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s10840-022-01406-7","article-title":"Clinical utility of remote monitoring for patients with cardiac implantable electrical devices","volume":"66","author":"Yang","journal-title":"J Interv Card Electrophysiol"},{"issue":"15","key":"R30","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1056\/NEJMp2033275","article-title":"Remote patient monitoring - overdue or overused?","volume":"384","author":"Mecklai","journal-title":"N Engl J Med"},{"issue":"24","key":"R31","doi-asserted-by":"publisher","first-page":"2463","DOI":"10.1016\/j.jacc.2022.05.004","article-title":"Resigned to the \u201cGreat Resignation?\u201d","volume":"79","author":"Fry","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"R32","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.1111\/jce.16328","article-title":"Switching to a 100% remote follow-up of implantable cardiac electronic devices: organizational model and results of a single center experience","volume":"35","author":"Miracapillo","journal-title":"J Cardiovasc Electrophysiol"}],"container-title":["JMIR Cardio"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/cardio.jmir.org\/2025\/1\/e66215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:59Z","timestamp":1785536939000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardio.jmir.org\/2025\/1\/e66215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":32,"URL":"https:\/\/doi.org\/10.2196\/66215","relation":{},"ISSN":["2561-1011"],"issn-type":[{"value":"2561-1011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,4]]},"article-number":"v9i7e66215"}}