The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up

Abstract

A b s t r a c t Background:The population of patients with implanted cardioverter-defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT-D) is constantly growing. The use of remote-monitoring (RM) techniques in this group can significantly improve clinical outcomes, but there are limited data about the impact of RM on healthcare costs from a payer's perspective. Aim:The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICD or CRT-D. Methods:We examined a cohort of 842 patients with ICD or CRT-D. The group was divided into two groups based on RM (or no RM [NRM]), matched according to important clinical characteristics. The subjects were followed for a maximum of three years after implantation (mean follow-up 2.11 ± 0.83 years). The overall costs for the healthcare provider in the follow-up were defined as the primary endpoint. The secondary endpoint was the use of different types of medical contact events: hospitalisation and number of in-clinic and general practitioner visits (without the number of remote transmissions). Results:In the three-year follow-up, the reduction in the costs of treatment for National Health Care in the RM group was 33.5% (median value, p < 0.001). In patients with implanted CRT-D, the reduction reached 42.7% (p = 0.011), and with ICD it was 31.3% (p = 0.007). We observed no significant reduction in the median hospitalisation costs in the three-year follow-up in the RM group (p = NS), despite a 25% drop in the mean value. The costs of outpatient visits were slightly higher in the RM group (p = NS). In the follow-up period, there was no reduction in the number of medical contact events (p = NS). Conclusions:Remote monitoring in patients with implanted ICD or CRT-D devices reduces the cost for the national healthcare provider.

No benefits from exercise training and worse outcomes in heart failure patients with atrial fibrillation and cardiovascular implantable electronic devices.

“…The concept of possible successful AFib ablation (pulmonary vein isolation) proposed by some authors is controversial due to the growing number of arrhythmia substrates in heart failure patients which limits procedure efficacy in the longer term perspective, although the results of the CASTLE-AF study are optimistic [34,35] . Potentially beneficial but still limited impact of tele-monitoring to enhance the care in many clinical aspects in cardiac devices recipients should be taken into account [36] .…”

Telemedicine in cardiology – prospects, risks and health inequalities

“…The number of cardiological patients is still increasing, and therefore implantable electronic devices are used more often [3,16]. Remote monitoring of patients enables early detection of AF or ventricular arrhythmia, assessment of treatment effectiveness and detection of disorders in the operation of the used device, for instance, a battery that is running out [17,18]. It is critically important in the case of children, as it has been previously shown that children are rarely aware of their symptoms or are not able to report them, especially when the events happen during sleep or physical activity [19].…”

Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

“…The IN-TIME RCT showed that using the remote monitoring abilities of the ICD and CRT devices leads to a reduction of a combined endpoint of all-cause death, overnight HF-related hospitalisation, change in New York Heart Association (NYHA) class, and change in patient global self-assessment [19]. However, other trials found no significant effect on patient outcomes [20,21]. The effect of remote monitoring using ICD/CRT devices has recently been investigated in a meta-analysis, including 11 RCTs (5702 patients).…”