Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis

Chew, Derek S.; Zarrabi, Mahmood; You, Isabelle; Morton, James; Low, Aaron; Reyes, Lucy; Yuen, Brian; Sumner, Glen; Raj, Satish R.; Exner, Derek V.; Wilton, Stephen B.

doi:10.1016/j.cjca.2022.01.022

Cited by 19 publications

(24 citation statements)

References 37 publications

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“…In line with findings from prior observational studies and pooled analysis of 2405 patients from the IN-TIME, ECOST, and TRUST trials, we observed a significant reduction in all-cause mortality in patients using RM compared with in-office follow-up. 9 , 14 , 20 , 21 Contrary to these prior studies, this is the first to include both patients with severely reduced LVEF as well as mildly reduced and normal LVEF. In the present analysis, there was no significant interaction between LVEF and RM for the probability of all-cause mortality, which suggests survival benefit outside of a heart failure indication.…”

Section: Discussionmentioning

confidence: 99%

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

et al. 2023

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Aims Remote monitoring (RM) for implantable cardioverter-defibrillators (ICDs) is advocated for the potential of early detection of disease progression and device dysfunction. While studies have examined the effect of RM on clinical outcomes in carefully selected populations of heart failure patients implanted with ICDs from a single vendor, there is a paucity of data in real-world patients. We aimed to assess the long-term effect of RM in a representative ICD population using real-world data. Methods and results This is an observational retrospective longitudinal study of 1004 patients implanted with an ICD or cardiac resynchronization therapy device (CRT-D) from all device vendors between 2010 and 2021. Patients started on RM (N = 403) within 90 days following de novo device implantation and yearly in-office visits were compared with patients with only bi-yearly in-office follow-up (non-RM, N = 601). In a propensity score matched cohort of 430 patients (mean age 61.4 ± 14.3 years, 26.7% female), all-cause mortality at 4-year was 12.6% in the RM and 27.7% in the non-RM group [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.32–0.82; P = 0.005]. No difference in inappropriate ICD-therapy (HR 1.90, 95% CI 0.86–4.21; P = 0.122) was observed. The risk of appropriate ICD-therapy (HR 1.71, 95% CI 1.07–2.74; P = 0.026) was higher in the RM group. Conclusion Remote monitoring was associated with a reduction in long-term all-cause and cardiac mortality compared with traditional office visits in a real-world ICD population.

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Section: Discussionmentioning

confidence: 99%

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

et al. 2023

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“…In a recent study, Chew et al studied the clinical and economic outcomes associated with RM, and similar to the present study found that patients who were constantly remotely followed were of younger age and also more likely to have an ICD in place. 6 This process is likely multifactorial and includes decreased/lack of digital literacy and hesitancy to adopt new health technologies, visual impairment, and cognitive dysfunction in elderly patients. In our present data, RM was significantly associated with college education and European American ancestry, indicating that despite being offered to all patients at the time of implantation, significant barriers for usage of RM remain present in our health care system.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Remote monitoring (RM) has emerged as an invaluable tool for device follow‐up by allowing for provider and patient‐triggered transmission of stored CIED data for review by health care professionals. 3 RM has been associated with reduced hospitalizations, shorter hospital stays, and lower hospital costs, 4 , 5 , 6 and has been shown to be complementary to in‐person office visits. 7 , 8 …”

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confidence: 99%

Real‐World Disparities in Remote Follow‐Up of Cardiac Implantable Electronic Devices and Impact of the COVID‐19 Pandemic: A Single‐Center Experience

Lehmann

Sharma

Bhatia

et al. 2023

JAHA

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Background Remote monitoring (RM) of cardiac implantable electronic devices has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in use and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in cardiac implantable electronic device RM. Methods and Results This was a retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted cardiac implantable electronic device or device upgrade between January 2017 and December 2020 were included. Patients were classified as RM positive (RM+) when they underwent at least ≥2 remote interrogations per year during follow‐up. Of all eligible patients, 2520 patients were included, and 34% were women. The mean follow‐up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, whereas 26% were implantable cardioverter‐defibrillators, and 8% were cardiac resynchronization therapy with implantable cardioverter‐defibrillators. Most patients (83%) were of European American ancestry. During follow‐up, 66% of patients were classified as RM+. Patients who were younger, European American, college‐educated, lived in a county with higher median household income, and were active on the hospital's patient portals were more frequently RM+. In an adjusted regression model, RM+ remained associated with the use of the online patient portal (odds ratio [OR], 2.889 [95% CI, 2.387–3.497]), presence of an implantable cardioverter‐defibrillator (OR, 1.489 [95% CI, 1.207–1.835]), advanced college degree (OR, 1.244 [95% CI, 1.014–1.527]), and lastly with European American ancestry ( P <0.05). During the years of the COVID‐19 pandemic, the number of RM+ patients increased, whereas the association with ancestry and ethnicity decreased. Conclusions Despite being offered to all patients at implantation, significant disparities were present in cardiovascular implantable electronic device RM in this cohort. Disparities were partly reversed during COVID‐19. Further studies are needed to examine health center‐ and patient‐specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.

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“…Ideally, reimbursement models should be aligned with the broader goals of the health care system, which may include access, sustainability, quality, and equity. RM could decrease health care costs by reducing and shortening hospital stays if implemented properly 83 . Innovative models may be required to facilitate the goals of access and equity, particularly among patients without cell phone coverage or internet access 96 .…”

Section: Section 2 General Conceptsmentioning

confidence: 99%

“…Lack of reimbursement is frequently cited as a barrier to widespread adoption of RM 86,94 that varies widely by country, 15 and within country by health jurisdiction. 95 Recommendation-specific supportive text 83 Innovative models may be required to facilitate the goals of access and equity, particularly among patients without cell phone coverage or internet access. 96 Without focused policy efforts, there is a risk of exacerbating care disparities and excluding vulnerable patients from the potential benefits of RM.…”

Section: Synopsismentioning

confidence: 99%

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

Ferrick,

Raj,

Deneke

et al. 2023

Journal of Arrhythmia

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Developed in partnership with and endorsed by the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS), and in collaboration with and endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the International Society for Holter and Noninvasive Electrocardiology (ISHNE), and the Pediatric and Congenital Electrophysiology Society (PACES).

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Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis

Cited by 19 publications

References 37 publications

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

Reduction in long-term mortality using remote device monitoring in a large real-world population of patients with implantable defibrillators

Real‐World Disparities in Remote Follow‐Up of Cardiac Implantable Electronic Devices and Impact of the COVID‐19 Pandemic: A Single‐Center Experience

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

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