CARDIAC IMPLANTABLE ELECTRONIC DEVICE ADVISORIES: CREATING A STREAMLINED APPROACH FOR THE MANAGEMENT OF AFFECTED PATIENTS (CCC-155)

Workshop Description: Cardiac implantable electronic devices (CIEDs) such implantable cardioverter-defibrillators and pacemakers can be life-saving and improve patient outcomes and quality of life. However, they are associated with long-term risks and adverse safety events. CIED generator and lead advisories pose significant safety concerns and require timely intervention by expert teams. Potential advisories include, but are not limited to: hardware or software malfunction leading to significant problems such as inappropriate cardiac device pacing or shock therapy, cessation of device function, and premature battery depletion. To mitigate the risk, clinical recommendations may include device reprogramming, increased surveillance through remote monitoring, or urgent device/ lead replacement. Advisories can have significant impact on patients’ psychological well-being and may require individualized education and support.
The vast array of guideline-based clinical recommendations requires intense resource reallocation facilitated by prompt communication among Administration, Physician and Nursing leadership leading to education, assessment and determination of appropriate intervention by the Device Clinic team members. Managing device and/or lead advisories creates additional workload for Device Clinic care-providers and can be challenging to navigate. Contemporary data suggest up to 33% of CIED patients were subject to an advisory in the previous decade, resulting in more than 1700 additional hours per patient advisory, highlighting resource and workforce challenges.
It is important for Device Clinics to develop a collaborative, facilitated multi-disciplinary approach to streamline care and management of CIED advisories. This may include: outlining the vendor, national and provincial level administrative roles and responsibilities, designating specific tasks and associated timelines for team members, and ensuring patients receive timely notification, support and education. The role of remote monitoring is particularly important to include in advisory management as many Device Clinics provide care to large populations living in remote and rural areas.
The purpose of this workshop is to share strategies, learning tools and improvement opportunities to manage advisories and facilitate a national, synergistic approach to standardize the process. A multi-disciplinary panel of presenters will facilitate an interactive session in which clinical considerations, operational workflows, and patient perspectives will be addressed. This workshop will provide attendees with evidence-based tools and innovative strategies that can be adopted in all CIED Clinics across Canada while delivering optimal care to our patients in the event of a CIED advisory.