Post-implantation CIED follow up is the key to successful therapy delivery, as device programming is tailored to the patients’ changing conditions. Moreover, much diagnostic information is collected by up-to-date CIEDs to integrate and assist the clinical management of patients beyond the pure rhythm disease management.
Though the importance of device follow up is widely appreciated by the personnel involved in the clinical care for stroke prevention and heart failure management it is largely undervalued in many countries. A recent European study has set the premises to establish adequate resource allocation for CIED follow up (Europace 2011; 13:1166-73).
Italy has a nation-wide public health system, where CIED follow up is not covered by the reimbursement for the disease under treatment (cardiac rhythm disorder or Heart failure). The expenses are not negligible, as ICD follow up is recommended every 3 months, and pacemaker every 6 months, in actual guidelines.
Such a policy is unfair compared to other medical-device recipients (cardiac valves, vascular stents) who do not pay for long term monitoring of the implanted device.
We believe that the value of CIED follow up needs to be completely revised, and appropriate reimbursement be set either for remote or in-hospital device check (see also Follow Up).