Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial - testing execution of the recommendations

Varma, Niraj; Michalski, Justin; Stambler, Bruce S.; Pavri, Behzad B.; Investigators, Trust

doi:10.1093/eurheartj/ehu066

Cited by 86 publications

(86 citation statements)

References 18 publications

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Section: Introductionmentioning

confidence: 99%

“…(5,6) In addition, patient compliance to scheduled remote monitoring evaluation is superior compared to in-office checks. (5) Home monitoring is relatively new in Southeast Asia, (1,7) with pickup rates increasing over recent years. We report our experience with home monitoring among patients with Medtronic (Medtronic Inc, Minneapolis, MN, USA) devices in this pilot study, which aimed to describe patient compliance to scheduled remote monitoring transmissions as well as physician, patient and healthcare workers' experiences with remote monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

Lim

Lee

Chua

et al. 2016

smedj

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INTRODUCTIONRemote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink ® network. METHODSPatients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. RESULTSA total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

Lim

Lee

Chua

et al. 2016

smedj

View full text Add to dashboard Cite

show abstract

“…This generates an enormous clinical workload which increases further when devices approach ERI, or in response to product advisories and recalls. The application of e-Health and Telemedicine for remote monitoring of patients with implanted devices may provide mechanism(s) for facilitating these tasks [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Data are promising and it can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms.…”

Section: Remote Monitoring Of Patients With Devicesmentioning

confidence: 99%

“…Data are promising and it can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. We expect that data retrieved from these systems will form an integral part of the electronic patient record in the future as more and more outpatient clinic care will shift to personalized care provided at a distance, in other words at patients' homes [36]. A provider perspective in five European countries on costs and net financial impact of follow-up with and without remote monitoring indicates, that for all patients as a whole, follow-up related costs for providers are not different for remote versus purely in-office follow-up, despite reorganized care.…”

Section: Remote Monitoring Of Patients With Devicesmentioning

confidence: 99%

E-Health and Telemedicine: Current Situation and Future Challenges

Saner¹

2016

Kardiol. serdechno-sosud. khir.

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“…17 It allows improved adherence to follow-up, 18 reduces healthcare utilisation 8,19 and is invaluable for monitoring device function. 20 Furthermore, it allows generation of large amounts of data for scientific research 21 and quality control (e.g.…”

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confidence: 99%

Is There a Future for Remote Cardiac Implantable Electronic Device Management?

Burri

2017

Arrhythmia &Amp; Electrophysiology Review

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Remote follow-up and monitoring of patients implanted with cardiac implantable electronic devices (CIEDs) has been introduced over a decade ago, and is now indicated according to European (class IIa indication 1 ) and American (class I indication 2 ) guidelines. There have been high expectations that this technology will improve patient outcome, as it significantly shortens response to actionable events (e.g. AF) compared with standard in-office follow-up. 3,4 However, several randomised trials have failed to meet this promise. 5,6The remote management of heart failure using implanted devices and formalised follow-up procedures (REM-HF) study has been published recently. 7 This trial, conducted at nine centres in England, randomised 1650 patients implanted with an ICD, cardiac resynchronisation therapy defibrillator or cardiac resynchronisation therapy pacemaker to either remote management with weekly transmissions or to usual care.After a median follow-up of 2.8 years, there were no differences in the primary outcome of mortality or cardiovascular admissions, nor in any of the secondary endpoints (although there was a trend in reduced mortality). This study is remarkable in that it is -as yet -the largest study in this field, with the longest follow-up, few exclusion criteria (e.g. AF was admissible and there was no age limit), and included devices from three major manufacturers. The results were disappointing: there were no differences in the primary endpoint of total mortality or cardiovascular hospitalisation, nor in any of the secondary endpoints. However, there are a number of points that need to be discussed.First, the study was performed in tertiary expert centres where specialised heart failure clinics already manage these complex patients to a high level of quality of care. Therefore, incremental benefit of any intervention is likely to be more difficult to achieve, and results may not be extrapolated to other less specialised settings.Second, this was not a study randomising remote device management with standard in-office care, as patients in the control group could be remotely monitored (except to manage heart failure). Third, the active group required weekly transmissions to be actively performed by the patients, with almost 40 % of patients transmitting <75 % of the time at 2 years. This is in contrast to automatic pre-defined alerts, which are the usual form of remote management, and that achieve successful transmissions in >90 % of the time. In any process aiming to improve patient outcome, three fundamental factors are implicated: 1) availability of good data, 2) proper interpretation of these data and 3) generation of meaningful action.In the case of REM-HF, there was most probably data overload, with parameters that are sometimes difficult to interpret individually (e.g. transthoracic impedance, heart rate variability etc.). This is probably one of the reasons why so little action was taken. For the reasons detailed above, it is not surprising that the study was negative.The key to improving ...

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Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial - testing execution of the recommendations

Cited by 86 publications

References 18 publications

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

E-Health and Telemedicine: Current Situation and Future Challenges

Is There a Future for Remote Cardiac Implantable Electronic Device Management?

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