# Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices

> **NIH NIH P20** · DARTMOUTH-HITCHCOCK CLINIC · 2024 · $210,975

## Abstract

PROJECT SUMMARY/ABSTRACT
Project 2 (Zeitler): Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices
Patients in rural settings have significantly worse outcomes from cardiovascular conditions compared with
patients in non-rural settings, including treatment of arrhythmias with a cardiac implantable electronic device
(CIED), like a pacemaker or defibrillator. These ubiquitous implantable devices store copious amounts of
medical information related to device function and disease progression, among other items. These data are
available to treating physicians and other clinicians through remote monitoring (RM), which relies on wireless
connectivity between patients, a remote server, health care facilities, and treating physicians. Monitoring of
patients with a CIED through this RM paradigm as an adjunct to periodic in-person evaluations has been
associated with a variety of improved outcomes over in-person evaluations alone, ranging from improvements
in patient satisfaction to decreased mortality. Thus, RM is unequivocally recommended in combination with in-
person evaluations. While known disparities in RM exist among the uninsured and elderly, the geographic
distribution of RM remains unstudied.
A number of factors suggest that RM of CIEDs may be particularly vulnerable to geographic disparities. For
one, patients in rural areas face greater barriers to connectivity, including less access to high-speed internet
and less-consistent cell phone coverage. These barriers couple with the challenge of greater geographic
distances that must be traveled to access in-person subspecialty services, a necessary aspect of CIED care.
With the guidance of a community engagement studio, the proposed work incorporates mixed methods to: 1)
better understand barriers and facilitators of RM in rural areas; 2) identify geographic disparities in CIED care;
and 3) exploit variation in RM referral networks to understand characteristics associated with optimal CIED
care in rural areas. These efforts will be informed and supported by expert input from the Statistics,
Informatics, and Qualitative Methods Core to evaluate variation in health care delivery and outcomes, as well
as the deep experience in community engagement and qualitative research methods represented by the
Community Engagement and Outreach Core. Findings from this research will constitute meaningful progress
towards addressing geographic disparities in arrhythmia care while, enabling achievement of investigator
independence.

## Key facts

- **NIH application ID:** 10816385
- **Project number:** 5P20GM148278-02
- **Recipient organization:** DARTMOUTH-HITCHCOCK CLINIC
- **Principal Investigator:** Emily Zeitler
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $210,975
- **Award type:** 5
- **Project period:** 2023-04-01 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10816385

## Citation

> US National Institutes of Health, RePORTER application 10816385, Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices (5P20GM148278-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10816385. Licensed CC0.

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