{
  "abstract": "Introduction Implantable Loop Recorders (ILRs) are increasingly used for long-term ambulatory heart rhythm monitoring to detect arrhythmia. In at-risk individuals, particularly, ILR use can be cost-effective. 1 However, patient experience with this invasive monitoring strategy is important to understand as wearables may promise a viable alternative in the future. As part of a wider scoping review addressing the question ‘What are patient preferences for ambulatory rhythm monitoring and what factors affect engagement with their use?’ we aimed to explore patient experience with ILRs, including how many studies address this issue, in what populations it is reported and how data has been collected to understand implications for future clinical care?Methods We conducted a mixed-methods scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for Scoping Reviews. Searches were performed in PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Google Scholar. We included quantitative and qualitative studies on adult patient choice and engagement with ambulatory heart rhythm monitoring published in any year. We report here evidence relating to ILRs. Data integration was performed at the analysis stage and presented using a joint display table.Results 867 papers were identified through the initial search. After removing duplicates and full-text review, 49 studies addressed patient choice or engagement with ambulatory heart rhythm monitoring. 14 focused on ILR devices and were included, of which 12 were original research and two were review articles.The primary indication for ILR insertion was to investigate symptoms or syncope. ILRs led to a range of physical, emotional, and psychological effects, which varied according to patient cohort and context [table 1]. Whilst the device offered security and empowerment for some, others experienced significant health-related anxiety. ILR implantation improved the self-perceived relationship with healthcare professionals, although this was contingent on communication and patient expectations.Conclusion ILR implantation is an attractive option for prospective arrhythmia surveillance in high-risk individuals. However, the evidence suggests complex and sometimes negative effects of ILRs on patient experience, potentially limiting engagement and reducing diagnostic utility. There is insufficient work done to understand interactions in sub-groups. Developing non-invasive technologies may in the future offer comparable monitoring with better patient experience and understanding patient preferences will be key to ensuring health care provision that meets patient need whilst improving outcomes.Reference Rinciog CI, Sawyer LM, Diamantopoulos A, Elkind MSV, Reynolds M, Tsintzos SI, et al. Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the UK. Open Heart 2019;6(1).Abstract 4-007 Table 1Joint display table showing data relating to the patient experience of implantable loop recorders (ILRs) Theme Quantitative Qualitative Interpretation Understanding arrhythmia and monitoring USA/ Germany/ UK / Japan, survey (Likert scales) showed poor patient education for a range of ambulatory monitoring devices, but slightly better for ILRs (n=214) ‘I never felt it happen…my heart would go from like 80 beats a minute up to over 130... That’s the arrhythmia that they discovered, but I didn’t even know I had it’ Both data types suggest poor understanding of arrhythmia and ILRs. Role of healthcare professional and device insertion Insertion of an implantable loop recorder (ILR) device by a nurse (n=189) or clinician (n=132) was equally successful (100%) and had a high rate of satisfaction (99% and 97%) based on yes/no survey question58% of patients (n=12) who had an ILR inserted for symptom investigation reported it was inserted at clinician request ‘I was just ready to put in anything… they're the expert... They told me I needed it. I said put it in’ ‘They recommended, who am I to say; He [ clinician ] suggested it, and I agreed with it.’ ‘I feel like they work as a team... I could've said no just as quick as I said yes... this is an option and I opted to have it.’ Patients have a high level of trust in clinicians and can adopt a passive role in the decision-making process.ILR devices can be inserted by non-clinicians with quality of care maintained. Cosmetic effect 93% of patients (n=30) felt the cosmetic result was at least satisfying at 3-month follow-up Patients with end stage renal disease on dialysis had concerns about the appearance of an ILR, stating ‘NO more battle scars’ and ‘Would I be able to see a big knot?’ Patients with chronic diseases may have unique concerns about an ILR’s appearance, which are less prevalent in a general population. Empowering the patient ‘Feeling of safety and being free of worry, … ICM was present and helping.’ ‘It does give me that feeling like something is watching all the time, like 24/7 diagnostic’ ‘Knowing was described as understanding the generated data from the ICM’ ILR insertion can generate a sense of confidence and support for patients, as its permanently in-situ. However, for the ILR to provide this, patients needed to understand purpose and the information it provides. Uncertainty 18/30 patients felt safer with an ILR but the same number feared future events (Likert scale)At 6 months post ILR, 33/35 patients were not worried and 70% felt safer (Likert scale). However, 20% felt sicker and that their privacy was invaded. ‘The uncertainty is the worst part. It can eat you up from the inside... all you can do is wait for an attack or episode to happen before you can get any diagnosis’ A significant minority of patients continue to experience or develop negative psychological effects despite ILR insertion. Quality of Life 97% of patients with ILRs did not feel it affected quality of life at 3-months (Yes/No survey question, n=30)ILR did not impair quality of life for patients being investigated for symptoms of arrhythmia or syncope (Yes/No survey question, n=33) Patients reported that the use of ILRs could alter their daily routine leading to a change in ‘personal and social identity’ Discordance between the quantitative and qualitative data suggests surveys may not always pick up the nuances of how ILRs affects an individual’s daily life. Abstract 4-007 Figure 1Prisma diagram showing study selection",
  "authors": [
    {
      "affiliations": [
        "University of Sunderland, Sunderland. UK",
        "Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Michael Bennett"
    },
    {
      "affiliations": [
        "Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Bill Chaudry"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Laura Ternent"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Tomos Robinson"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK",
        "Adult Congenital Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Louise Coats"
    }
  ],
  "title": "4-007 Understanding the experience of patients with implantable loop recorders: a scoping review",
  "uid": "b3adfe1a-18d0-5135-8fcc-d77b42607c2c"
}