No abstract

Aims: The population of patients with implanted cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT -Ds) 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. The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICDs or biventricular-ICDs in a real-world cohort. Methods: We examined a cohort of 842 patients with ICDs or CRT -Ds.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 3 years after implantation (mean follow-up2.11 + 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: hospitalization and number of in-clinic and general practitioner visits. Results: In the 3-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-Ds, the reduction reached almost 43%( p ¼ 0.011) and with ICDs was more than 31 (31,3) % ( p ¼ 0.007). We observed no significant reduction in the median hospitalization costs in the 3-year follow-up in the RM group ( p ¼ NS), despite 25% drop in the mean value. Costs of outpatient visits were slightly higher in the RM group ( p ¼ NS). In the follow-up period, there was no reduction in the number of medical contacts events ( p ¼ NS Purpose of the study: Breathing disorders are common but still underdiagnosed in patients with cardiovascular disease. Sleep apnea is associated with increased cardiovascular risk, especially in patients with heart failure, thus diagnosing and possibly treating apnea is an issue in the management of the disease. Some pacemakers (PM) and implantable cardioverterdefibrillators (ICD) are now able to monitor intrathoracic impedance for automatic detection of sleep apnea events. The aim of the study was to evaluate the performance of the Respiratory Disturbance Index (RDI) calculated by the ApneaScan algorithm (Boston Scientific). Method used: Patients underwent overnight polysomnography and the apnea-hypopnea index (AHI) was computed as the number of apneas and hypopneas divided by analyzed time minus movement time and standing position time. The PM/ICD-derived RDI value was simultaneously recorded and compared to the AHI, considered as gold-standard measurement. Summary of results: Twenty-eight patients (aged 71 + 8 years, 18 males) were studied. Seventeen patients received an ICD and the remaining patients a PM. The mean AHI value during the study night was 21 + 17 episodes/h while the mean RDI was 33 + 22 episodes/ h. RDI values correlated with AHI (r ¼ 0.81, p , 0.001). The Bland-Altman agreement analysis of AHI-RDI revealed a bias between measurements of...