Remote monitoring in remote places: an archipelago experience in heart failure patients with cardiac electronic devices

Abstract

Introduction and objectivesRemote monitoring (RM) is a new tool in heart failure (HF) patients with cardiac implantable electronic devices but its effect in clinical outcomes is still uncertain. In remote regions as islands HF management is even more challenging and RM may have a different impact. We aimed to assess its impact in clinical outcomes in an insular reality. MethodsThis was a retrospective, non-randomized study conducted in our hospital, that is the reference center of a nine-island archipelago. Patients in the HF remote monitoring program were matched 1:1 with usual standard of care patients. ResultsFrom 307 patients, 96 with RM (group 1 – G1) were matched 1:1 according to age ±2 years and gender with 96 usual standard of care (group 2 – G2) (mean age 69 years, 76% males, mean follow-up period 55 months). Primary endpoint was cardiovascular (CV) mortality and secondary endpoints all-cause mortality, HF hospitalizations at 12 months and at FUP. CV mortality was lower in G1 (hazard ratio [HR] 6.7; 95% confidence interval [95% CI] 1.46–30.87; P=.004), as well as all-cause mortality (HR, 5.7; 95% CI, 1.85–17.39; P<.001) and HF hospitalizations at 12 months (P=.02) with a tendency toward less hospitalizations during follow-up. ConclusionsRM in the management of HF patients with cardiac implantable electronic devices in a remote geographic location, as a nine-island archipelago, was effective in reducing CV mortality, all-cause mortality and HF hospitalizations.