Alert-Based ICD Follow-Up

Varma, Niraj; Love, Charles J.; Michalski, Justin; Epstein, Andrew E.

doi:10.1016/j.jacep.2021.01.008

Cited by 23 publications

(42 citation statements)

References 31 publications

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“…biventricular pacing percentage), RM could provide physicians with information on the cardiac status real time and enable timely undertaking of preventative action. 6 , 18 Similar to a recent study by Varma et al ., 19 the number of ICD-related patient contacts was substantially higher in patients on RM compared with in-office follow-up, which confirms the intensified evaluation offered by RM. In line with findings from prior observational studies and pooled analysis of 2405 patients from the IN-TIME, ECOST, and TRUST trials, we observed a significant reduction in all-cause mortality in patients using RM compared with in-office follow-up.…”

Section: Discussionsupporting

confidence: 63%

“…Varma et al . 19 assessed the actionability of in-office evaluations (defined as anti-arrhythmic medication change or significant ICD re-programming/system revision) in patients using RM and patients with in-office visits every 3 months, demonstrating similar percentage of actionable visits between these groups. Differences in RM regime and frequency of in-office follow-up limit the generalizability of findings and further emphasize the need for prospective, real-world data.…”

Section: Discussionmentioning

confidence: 99%

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Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

et al. 2023

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Aims Remote monitoring (RM) for implantable cardioverter-defibrillators (ICDs) is advocated for the potential of early detection of disease progression and device dysfunction. While studies have examined the effect of RM on clinical outcomes in carefully selected populations of heart failure patients implanted with ICDs from a single vendor, there is a paucity of data in real-world patients. We aimed to assess the long-term effect of RM in a representative ICD population using real-world data. Methods and results This is an observational retrospective longitudinal study of 1004 patients implanted with an ICD or cardiac resynchronization therapy device (CRT-D) from all device vendors between 2010 and 2021. Patients started on RM (N = 403) within 90 days following de novo device implantation and yearly in-office visits were compared with patients with only bi-yearly in-office follow-up (non-RM, N = 601). In a propensity score matched cohort of 430 patients (mean age 61.4 ± 14.3 years, 26.7% female), all-cause mortality at 4-year was 12.6% in the RM and 27.7% in the non-RM group [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.32–0.82; P = 0.005]. No difference in inappropriate ICD-therapy (HR 1.90, 95% CI 0.86–4.21; P = 0.122) was observed. The risk of appropriate ICD-therapy (HR 1.71, 95% CI 1.07–2.74; P = 0.026) was higher in the RM group. Conclusion Remote monitoring was associated with a reduction in long-term all-cause and cardiac mortality compared with traditional office visits in a real-world ICD population.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

et al. 2023

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“…In the RM-ALONE study the reduction in in-office visits was even 83% [ 41 ]. In the TRUST study, a fully remote alert-based RM was associated with a reduction of 81% in nonactionable events, while actionable events remained unchanged [ 6 ••]. This all occurred without an increase in major cardiac events [ 6 ••, 40 , 41 ].…”

Section: Benefits Of Remote Monitoringmentioning

confidence: 99%

“…In the TRUST study, a fully remote alert-based RM was associated with a reduction of 81% in nonactionable events, while actionable events remained unchanged [ 6 ••]. This all occurred without an increase in major cardiac events [ 6 ••, 40 , 41 ]. Furthermore, a recent cost-consequence sub-analysis of TRUST showed that an alert-based RM strategy was associated with a significant lower cost compared to in-person evaluations only and a remote follow-up strategy [ 42 ••].…”

Section: Benefits Of Remote Monitoringmentioning

confidence: 99%

“…Importantly, some manufacturers have devices that provide or can be programmed to provide daily remote transmissions (Table 1 ). Daily updates, to confirm patient connectivity and absence of alerts, allow near continuous RM and may facilitate an alert-based RM follow-up, a fully remote patient management strategy [ 6 ••, 7 •]. In this review, we will discuss recent evolutions in RM, practical considerations in RM, and identify barriers to facilitate optimal RM.…”

Section: Introductionmentioning

confidence: 99%

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Remote Patient Monitoring: What Have We Learned and Where Are We Going?

Vandenberk

Raj

2023

Curr Cardiovasc Risk Rep

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Purpose of Review Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is an important part of patient follow-up. The increasing number of patients with CIEDs and the recent pandemic pose several challenges for already limited device clinic resources. This review focuses on recent evolutions in RM and identifies future needs to improve RM. Recent Findings RM has been associated with multiple clinical benefits, including improved survival, early detection of actionable events, reduction in inappropriate shocks, longer battery lives, and more efficient healthcare utilization. The survival benefit was driven by studies using alert-based continuous RM with daily transmissions and fast reaction times. Patients report a high satisfaction rate without significant differences in quality of life between RM and in-office follow-up. The increasing workload, due to the increasing number of CIEDs implanted with daily remote transmissions, results in several challenges for the future of RM. RM requires appropriate reimbursement for RM device clinics to optimize patient/staff ratios, including sufficient non-clinical and administrative support. Universal alert programming and data processing may minimize inter-manufacturer differences, improve the signal-to-noise ratio, and allow the development of standard operating protocols and workflows. In the future, programming by remote control and true remote programming may further improve remote CIED management, patient quality of life, and device clinic workflows. Summary RM should be considered standard of care in management of patients with CIEDs. The clinical benefits of RM can be maximized by an alert-based continuous RM model. Adapted healthcare policies are required to keep RM manageable for the future.

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2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

Ferrick,

Raj,

Deneke

et al. 2023

Journal of Arrhythmia

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Developed in partnership with and endorsed by the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS), and in collaboration with and endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the International Society for Holter and Noninvasive Electrocardiology (ISHNE), and the Pediatric and Congenital Electrophysiology Society (PACES).

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Alert-Based ICD Follow-Up

Cited by 23 publications

References 31 publications

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

Remote Patient Monitoring: What Have We Learned and Where Are We Going?

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

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