Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators

Akar, Joseph G.; Bao, Haikun; Jones, Paul; Wang, Yongfei; Varosy, Paul D.; Masoudi, Frederick A.; Steín, Kenneth M.; Saxon, Leslie A.; Normand, Sharon‐Lise T.; Curtis, Jeptha P.

doi:10.1161/circep.114.003030

Cited by 58 publications

(57 citation statements)

References 26 publications

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“…It is, of course, of note that this was not a randomized study (the decision to place a patient in the remote follow-up system was a choice of the implanting physician, which means that a strong selection bias cannot be excluded; to account for such imbalances, the authors provide comparative survival data for 10 272 matched patients implanted with ICD and CRT-D devices on and off the network, where, similar to the entire cohort, follow-up on the network was associated with a 50% relative reduction in the risk of death: ICD hazard ratio 0.56; CRT-D hazard ratio 0.45; P < 0.0001). A similar survival benefit and clinical outcome improvement was shown in the more recent IN-TIME trial [18], as well as in national registries with more than 100 000 patients [19,20]. A 2011 abridged Cochrane Review found that telemonitoring (which, however, included the transmission of more parameters than simply ECG data) was also associated with a survival benefit [21].…”

Section: Survival Benefitsmentioning

confidence: 59%

Remote monitoring of the cardiac rhythm: where do we stand today?

Deftereos

Papoutsidakis

Giannopoulos

et al. 2016

Continuing Cardiol Educ

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Remote monitoring systems, in their current forms, are networked communication solutions allowing exchange of digitized data from implanted or wearable devices. These data usually include electrocardiographic recordings, but nowadays they may encompass much more than that, allowing a continuously updated knowledge of a multitude of device‐ or patient‐related parameters. Remote monitoring has been shown, as one would have expected, to reduce the need for office visits and allow earlier detection—and thus management—of arrhythmic events. However, although there are hints that they may also be associated with improved clinical outcomes, the absence of randomized trials dictates a cautious interpretation of existing evidence. Furthermore, there are still several questions regarding their cost‐effectiveness, the patient populations that could benefit from them, as well as how the transmitted data should be interpreted and acted upon by physicians. In this review, we present and critically examine the current state of affairs of remote cardiac rhythm monitoring systems. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4596216/Activity.aspx

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Section: Survival Benefitsmentioning

confidence: 59%

Remote monitoring of the cardiac rhythm: where do we stand today?

Deftereos

Papoutsidakis

Giannopoulos

et al. 2016

Continuing Cardiol Educ

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“…Recently, the PREDICT-RM trial demonstrated reductions in all-cause rehospitalization and all-cause mortality in a large cohort of patients after new ICD implantation who underwent RM during follow-up. 6 In the IN-TIME study, Hindricks et al 7 randomized 716 patients with left ventricular dysfunction who received an ICD (with or without CRT) to automatic, daily, implant-based telemonitoring vs. conventional followup in a single-blinded design. After one year, patients under RM had a lower composite score of all-cause mortality, admission for HF, change in NYHA class, and patient global self-assessment.…”

Section: Discussionmentioning

confidence: 99%

A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort

Portugal¹,

Cunha²,

Valente³

et al. 2017

Revista Portuguesa de Cardiologia

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Aims: There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs). Methods: We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death. Results: Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 2174-2049Document downloaded from http://www.elsevier.es, day 24/05/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. G. Portugal et al. Conclusion:In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death. © 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved. (HR 0,53; IC 0,04; p=0,066). Não se observaram diferenças entre grupos relativamente a terapêuticas apropriadas (MR versus seguimento convencional; 8,1 versus 8,2%, p=NS) ou terapêuticas inapropriadas (6,8 versus 5,0%, p=NS). Conclusão: Numa amostra emparelhada por propensity score de portadores de CDI, a MR associou-se a uma menor incidência de um evento composto de internamento por IC ou morte cardiovascular a longo prazo. PALAVRAS-CHAVE

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“…Recently, the PREDICT-RM trial demonstrated not only a reduction in all-cause rehospitalizations, but also in all-cause mortality in a large cohort of patients after newly ICD implantation who underwent RM during follow-up [6]. In the IN-TIME study, Hindricks, et al [7] randomized 716 patients with left ventricular dysfunction submitted to implantation of an ICD (with or without CRT) to automatic, daily, implantbased telemonitoring versus conventional follow-up in a single-blinded design.…”

Section: Discussionmentioning

confidence: 99%

Influence of remote monitoring on long-term cardiovascular outcomes after cardioverter-defibrillator implantation

Portugal

Cunha

Valente

et al. 2016

International Journal of Cardiology

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Aims: Device-based remote monitoring (RM) has been linked to improved clinical outcomes at short to mediumterm follow-up. Whether this benefit extends to long-term follow-up is unknown. We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICD). Methods: We performed a retrospective cohort study of consecutive patients who underwent ICD implantation for primary prevention. RM was initiated with patient consent according to availability of RM hardware at implantation. Patients with concomitant cardiac resynchronization therapy were excluded. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. A Cox proportional hazards model was employed to estimate the effect of RM on mortality and a composite endpoint of cardiovascular mortality and hospital admission due to heart failure (HF). Results: 312 patients were included with a median follow-up of 37.7 months (range 1 to 146). 121 patients (38.2%) were under RM since the first outpatient visit post-ICD and 191 were in conventional follow-up. No differences were found regarding age, left ventricular ejection fraction, heart failure etiology or NYHA class at implantation. Patients under RM had higher long-term survival (hazard ratio [HR] 0.50, CI 0.27-0.93, p = 0.029) and lower incidence of the composite outcome (HR 0.47, p = 0.008). After multivariate survival analysis, overall survival was independently associated with younger age, higher LVEF, NYHA class lower than 3 and RM. Conclusion: RM was independently associated with increased long-term survival and a lower incidence of a composite endpoint of hospitalization for HF or cardiovascular mortality.

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Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators

Cited by 58 publications

References 26 publications

Remote monitoring of the cardiac rhythm: where do we stand today?

Remote monitoring of the cardiac rhythm: where do we stand today?

A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort

Influence of remote monitoring on long-term cardiovascular outcomes after cardioverter-defibrillator implantation

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