Reducing Review Burden with Key EGM Selection
The key EGM selection tool evaluated in this study reduced the total number of EGMs to review for each arrhythmia type, and by 55.1% across all arrhythmias. Looking at patient EGM rates per month, rather than entire population totals, provides an informative view of how a minority of patients can overwhelm the patient care system. Key EGM selection resulted in a significant drop in median EGMs/pt/mo across the entire population. As expected, this reduction was even greater for patients in the top 25th percentile of EGMs/pt/mo, who accounted for almost 90% of all EGMs to review. In these high EGM-volume patients, the median EGMs/pt/mo dropped by 37.7%, 53.0%, 70.8%, and 48.1% for AF, tachycardia, bradycardia, and pause, respectively.
Resource Utilization Benefit
In a recent study of 1,811 ICMs (over 90% Medtronic), with nearly 1,500 total transmissions over a 4-week period, 15 ± 6 min was spent by clinic personnel and 1.5 ± 1 min by electrophysiologists per transmission.11 Based on the number of EGMs per transmission in that study, clinic personnel can be estimated to spend 0.6 min to review each EGM, plus a fixed time of 11.0 min per transmission for pre-review preparation and post-review record/patient processing, with an additional review time by electrophysiologists of 0.2 min per EGM. Applying these estimates to the current study, in which the EGM burden was reduced by 55.1% while maintaining the number of transmissions, the expected time saved per 100 patients in this cohort would be 120 hours/year for clinic personnel (28.7% reduction) and 36 hours/year for electrophysiologists (55.1% reduction).