Remote Cardiac Device Monitoring System Shows Safety and Cost Benefits

Regular in-clinic follow-up for patients with cardiac implantable electronic devices, including pacemakers and implantable cardioverter defibrillators, is resource intensive. As device use rises with aging populations and expanding indications, clinic capacity is increasingly strained. Missed or delayed checks can allow arrhythmias or device-related problems to progress before intervention. Against this backdrop, investigators have evaluated a virtual e-health system that remotely monitors device function and coordinates communication between patients and clinicians.

The Virtual E‑Health System (VIRTUES) was evaluated by researchers at Dalhousie University (Halifax, NS, Canada). The platform receives transmission reports from the patient’s implanted device, routes the data to physicians for review, and delivers tailored messages back to patients about device status. It aims to replace routine in‑person checks with structured remote monitoring while maintaining clinical oversight. The system was assessed in dedicated trials for pacemaker and implantable cardioverter defibrillator (ICD) patients.

Two randomized trials conducted across 13 centers in Canada enrolled 1,115 patients with compatible pacemakers or ICDs. Participants were assigned 1:1 to VIRTUES, which relied on remote monitoring and virtual-care communication, or to standard care involving in-clinic visits with or without remote monitoring. Follow-up lasted 18 months, and unscheduled clinic visits were available in both groups for device-related concerns. Participants had a mean age of 67 years, and 27% were women.

VIRTUES was noninferior to standard care on safety outcomes. For the composite of death, stroke, and cardiovascular- or device-related hospitalization at 18 months, event rates were 11.0% with VIRTUES versus 11.2% with standard care in the ICD trial and 6.1% versus 7.4% in the pacemaker trial. Efficacy, measured as the time from a clinically important event to a clinic decision, was also noninferior in the ICD trial, with a median difference of +1 day. In the pacemaker trial, results showed a signal of superiority favoring VIRTUES, with a median difference of −3.25 days.

Cost analyses showed an adjusted total difference of 77 Canadian dollars per patient in favor of VIRTUES, largely from fewer clinic visits, with an estimated annual savings of about 10 million Canadian dollars nationally. Patients reported strong support for the digital approach and described greater control through direct feedback on device function. The trials were presented in a Hot Line session at ESC Congress 2026, and the investigators noted potential global scalability pending regional studies.

“Globally, around 1.25 million people are implanted with devices like pacemakers every year. It is important to follow these patients over their lifetimes to check their devices are working well; however, this entails regular visits to specialist clinics, which can be burdensome for the patient and health care system,” said Professor Ratika Parkash, principal investigator at Dalhousie University, Halifax, Canada.

“We have shown that the VIRTUES system is both patient-centric and reduces the clinic burden, which can be challenging to demonstrate in digital health studies. The VIRTUES system could be scalable for use globally, although it has only been tested in Canada so far, and further studies would be needed in other regions," added Prof. Parkash.

Related Links
Dalhousie University
European Society of Cardiology