Patients with cardiac implantable devices could undergo routine pacing checks successfully at a drive-through clinic, one group learned during the COVID-19 pandemic.
A hospital set up a kiosk in the parking lot and limited appointments to 10 per day. From April 13 to June 8 this year, 316 patients drove up and stayed in their cars, where they were handed a programming wand for a full pacing check and optimization of parameters of their devices.
“Comprehensive checks were accomplished in the full range of devices to the satisfaction of patients and without adverse incidents, indicating feasibility,” according to researchers led by Zaki Akhtar, MBBS, of St. George’s University Hospital in London, reporting online in JACC: Clinical Electrophysiology.
The drive-through model may have advantages over remote monitoring given that kiosk workers were able to visually inspect implant sites and identify two people with superficial wound infections for antibiotic treatment, Akhtar’s group argued.
Moreover, remote monitoring may not be suitable for all individuals — patients with older cardiac devices that lack remote monitoring capabilities and people who don’t have Internet service at home, for example.
“The only technical challenge arose from the single patient requiring a surface ECG to better determine the pacing threshold. This patient was redirected to the in-hospital clinic for completion,” the investigators said.
Akhtar and colleagues conducted the study during the COVID-19 pandemic. Healthcare workers in the kiosk donned protective gear and wrapped the programming wand in a sterile polyethylene sleeve before giving it to patients.
The drive-through clinic averaged nine patients per day. The 316 people included in the study had a mean age of 78 years, and 62% were men.
Appointments were largely for routine follow-up visits. Two-thirds of people received pacing checks on pacemakers. The remainder had cardiac resynchronization therapy devices (21.8%), implantable cardioverter-defibrillators (4.1%), and loop recorders (7.3%).
In total, seven people were diagnosed with new atrial fibrillation and referred for anticoagulation. Device settings were adjusted in 51 cases, and 22 patients were referred to a physician clinic. No one required emergency electrical intervention.
A questionnaire was completed by 85.1% of people after their drive-through experience. Patients rated the drive-through clinic highly in consultation thoroughness and answering of all queries. People were slightly happier with the provided instructions at the conventional clinic at the hospital, but rated punctuality higher at the drive-through.
More than half of people said they preferred the drive-through over the conventional clinic.
“Cardiac arrests would be more difficult to treat in a car than in a clinic room; fortunately, these are rare in the pacing clinic, and none occurred in this experience,” Akhtar’s team noted.
Akhtar had no disclosures.
One co-author listed relationships with Attune Medical, Boston Scientific, and Cook Medical.