Remote Monitoring Reduces Healthcare Use and Improves Quality of Care in Heart Failure Patients With Implantable Defibrillators

Abstract

Background-Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits. Methods and Results-This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; Pϭ0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; PϽ0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (PϽ0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (Pϭ0.026). Conclusions-Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873899.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…55 They compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events.…”

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa

“…Regarding year of publication, nine articles were dated 2012 (15)(16)18,(20)(21)(22)(29)(30)(31) , followed by years 2011 (n=6) (11)(12)(13)17,19,23,33) , 2010 (n=4) de la salud que tratan de personas con insuficiencia cardiaca. Futuras revisiones sistemáticas con meta-análisis son necesarias para identificar las intervenciones más eficaces para mejorar la calidad de vida de estos individuos.…”

“…Regarding year of publication, nine articles were dated 2012 (15)(16)18,(20)(21)(22)(29)(30)(31) , followed by years 2011 (n=6) (11)(12)(13)17,19,23,33) , 2010 (n=4) (24)(25)32,34) , 2013 (n=3) (14,(27)(28) and 2008 (n=1) (26) . The articles were published in General Cardiology journals (12)(13)(16)(17)(18)20,22,(24)(25)(28)(29)(30)(31)(32)34) , followed by General Clinical journals (14)(15)(26)(27)33) . Two articles were published in Nursing journals (19,23) and one was published in a Nutrition journal (21) (Chart 1).…”

Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes

“…The evolving capabilities of implanted devices to monitor the patient’s status may imply a shift from device-centered follow-up to patient-centered follow-up [63]. In fact, telecardiology and remote control make it possible not only to evaluate the device parameters but also to detect arrhythmias and signs of worsening heart failure with a potentially important impact on clinical and economical outcomes [64]. In a group of patients with neuromuscular disorders and with a high risk of clinical events, remote monitoring could represent an important clinical opportunity, whose advantages are in addition to avoidance of the inconvenience of in-hospital checks, particularly tiresome in patients with neuromuscular involvement conditioning functional impairment.

10.1080/19491034.2018.1506680-F0005Figure 5.Remote monitoring of patients with an implanted device: the flow of information is characterized by transmission to physicians and nurses for appropriate decision-making on actionable clinical events.

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