Use of cell phone adapters is associated with reduction in disparities in remote monitoring of cardiac implantable electronic devices Nick Mantini 1 & Ryan T. Borne 1 & Paul D. Varosy 1 & Michael A. Rosenberg 1 & Lucas N. Marzec 1 & William H. Sauer 1 & Duy T. Nguyen 1,2 Received: 13 October 2019 /Accepted: 31 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Background Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is standard of care. However, it is underutilized. In July 2012, our institution began providing cell phone adapters (CPAs) to patients free of charge following CIED implantation to improve remote transmission (RT) adherence. Methods Patients in our institution’ s RM database from January 1, 2010, thru June 30, 2015, were retrospectively reviewed. There were 2157 eligible patients. Remote transmission proportion (RTP) and time to transmission (TT) were compared pre- and post-implementation of free CPA. Chi-squared analysis and Kruskal-Wallis tests were performed to compare RTP and TT. Results There was a significant increase in RTP (134 [18.4%] vs 99 [54.7%]; p < 0.001) and decrease in median TT in days (189[110– 279] vs 58 [10–149]; p < 0.001) after CPAs were provided to patients. Caucasian patients were more likely than African Americans and Hispanics to use RM prior to CPAs ( p = 0.04). After the implementation of CPAs, there was a significant increase in RTP for all racial groups (< 0.001) with no difference in RTP among racial groups (p = 0.18). The RTP for urban residents was significantly greater than non-urban residents with CPAs (p = 0.008). Patients greater than 70 years of age were significantly less likely to participate in RT before and after CPAs were provided ( p = 0.03, p = 0.01, respectively). Conclusions CPAs significantly improve RTP and reduce median TT for all patients regardless of race, geographic residence, and age (> 70 years old to lesser extent). Broad institution of CPAs following ICD implantation could potentially reduce disparity in RTP and deserves more study. Keywords Cardiac implantable electronic devices . Remote monitoring . Cell phone adapters 1 Introduction Permanent pacemaker (PPMs) and implantable cardioverter- defibrillator (ICD) interrogation at least once 2–12 weeks post- implantation has been associated with improved survival [1, 2]. Remote monitoring (RM) has emerged as a technology that per- mits patient triggered transmission of stored CIED data for re- view by healthcare professionals, which obviates the need for strict in-person device consultation. Prior studies have consistent- ly documented an array of benefits with RM that include an improvement in mortality, increase in the detection of events, and reduced time from clinical event to medical decision making [3–9]. Even in ICD trials that failed to demonstrate an improve- ment in mortality, the RM safety profile, including mortality, was at least non-inferior between in-office visits and remote monitor- ing [7, 10, 11]. Remote monitoring has also been associated with fewer hospitalizations, shorter hospital stays, and a lower rate of hospital payments [12, 13]. The capability for RM is near universal among currently implanted CIEDs, and its use is recommended as standard of care by the major professional societies [14]. However, it re- mains an underutilized technology [15]. Furthermore, there is evidence that enrollment in and activation of RM programs may be underused among patients with no health insurance, racial and ethnic minorities, and younger patients [16–18]. Accordingly, we sought to determine if a standardized dis- charge process, including the provision of cell phone adaptors (CPAs) and enrollment into the respective CIEDs online data- base at the time of discharge following implantation, im- proved adherence to remote monitoring. The CPAs are * Duy T. Nguyen duy.t.nguyen@stanford.edu 1 University of Colorado, Aurora, CO 80045, USA 2 Stanford School of Medicine, Room H2152, 300 Pasteur Dr, Stanford, CA 94305-5233, USA Journal of Interventional Cardiac Electrophysiology https://doi.org/10.1007/s10840-020-00743-9