To the Editor - Remote monitoring devices and the unseen challenges.

We read with interest the paper by Harvey and Seiler that successfully carried out a study to identify the challenges in managing a remote monitoring device clinic using a 27-item mixed-methods survey. The study highlighted connectivity, staffing, and technological education to be the major challenges. However, the use of these phrases within the 27-item mixed-methods survey may have subconsciously led participants to focus on these issues in the open-ended questions without identifying other potential issues with remote monitoring devices. This could have been altered by only using closed questions that included more questions about other potential concerns with monitoring or only open questions to allow participants to freely share their concerns without bias.

The response rate for the study was low considering the Heart Rhythm Society Allied Health Professional communities’ group, owing to the short time window, which could be increased in future studies. However, carrying out a study internationally requires a balance of responses between countries. In this case, most responses were from the United States, whereas Egypt and Australia each represented a single participant, leading to the study majorly applying to the United States. Hence, staffing and technological education may not have been an issue in countries such as Egypt, the United Kingdom, or Australia. Therefore, focusing the study to identify challenges in managing a remote monitoring device clinic in the United States alone may have been more suitable for this study.

The research identified large volumes of alerts as a flaw given by the remote cardiac monitoring devices. The manufacturer of the monitoring devices used by the participants in their respective hospitals to collect the data was not surveyed in this study. This would have allowed a potential novel area of research to overcome the flaws of the algorithms to reduce the volume of alerts.

Overall, the study highlighted many challenges faced in managing remote monitoring devices in clinics. Future research can build upon this study to resolve the challenges identified.