To describe natural changes in patient management that occurred during the COVID-19 pandemic, and the impact these changes had on patients.

Recently available models of VNS therapy offer a scheduled programming feature that permits programming events to occur on a predetermined schedule, outside of typical office visits.  During the COVID-19 pandemic, patient access to office visits has been limited, and remote patient management techniques, such as scheduled programming, have gained popularity. 

To examine changes in real-world feature use, a database of programming events at primarily North American centers and collected through standard post-market surveillance was examined.  The full year of 2018 (the year following release of this feature) was compared to the year of 2020, from March 1st through December 31st, when COVID-19 restrictions started to become more widespread in the United States.

Scheduled programming increased from 23.5% of all patients in 2018 to 30.5% in 2020.  While frequency of feature use increased during the pandemic, the typical method of feature use did not meaningfully change.  Of patients who used scheduled programming to titrate at least 1 step, the mean number of total steps titrated with this feature increased from 3.5 to 3.8 during the pandemic.  Use of scheduled programming decreases the frequency of office visits required to achieve a dose, but pre-pandemic and peri-pandemic reduction in office visits in patients that used scheduled programming were not meaningfully different (-2.1 visits in 2020 vs -1.9 visits in 2018).  During both time ranges, patients who experienced 3 or more scheduled programming events were more likely to achieve a target dose of 1.5 mA in less than three months.

These findings suggest that scheduled programming can support VNS dosing and titration in situations where remote patient management is encouraged.