Abstract
BackgroundRemote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory.ObjectiveThe aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center.MethodsThe population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up.ResultsThe mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P=.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P=.004).ConclusionsIn this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate.
Highlights
Remote monitoring of cardiac implantable electronic devices has proved to be beneficial on several clinical endpoints
[12] In the randomized, controlled, international multicenter IN-TIME study, a significant survival benefit of implant-based multiparameter telemonitoring was demonstrated over the standard of care in patients with heart failure and implanted dual-chamber implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) [13]
The REM-HF multicenter randomized study showed similar outcomes among patients with heart failure and cardiac implantable electronic devices utilizing remote monitoring with weekly downloads and a prespecified follow-up approach [15]. Concerning these contradictory results, we aimed to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing CRT-D implantation in a large-volume tertiary referral center
Summary
Remote monitoring of cardiac implantable electronic devices has proved to be beneficial on several clinical endpoints. Randomized studies proved that remote monitoring could reduce time to evaluate arrhythmic events [3], decrease mean length of cardiovascular hospitalizations [4], and could significantly lower the number of appropriate or inappropriate shocks [5]. This method is able to reduce in-office implantable cardioverter defibrillator (ICD) follow-up http://www.jmir.org/2019/7/e14142/ XSLFO RenderX. 1 (page number not for citation purposes) burden safely [6] Remote monitoring provided early detection of heart failure events and reduced the number of urgent in-office visits and total health care use in patients with ICD or cardiac resynchronization systems in diverse clinical studies [7,8,9]. Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; its ability to improve survival is contradictory
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
