Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial

Geller, J. Christoph; Lewalter, Thorsten; Bruun, Niels Eske; Táborský, Miloš; Bode, Frank; Nielsen, Jens Cosedis; Stellbrink, Christoph; Schön, Steffen; Mühling, Holger; Oswald, Hanno; Reif, Sebastian; Kääb, Stefan; Illéš, Peter; Proff, Jochen; Dagres, Nikolaos; Hindricks, Gerhard

doi:10.1007/s00392-019-01447-5

Cited by 28 publications

(18 citation statements)

References 42 publications

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“…The REM-HF study confirmed these results, showing that RPM did not reduce the incidence of cardiovascular events in a heart-failure cohort [ 5 ]. In contrast, the IN-TIME and TIM-HF-2 trials were able to show a potential benefit on clinical outcomes by RPM surveillance [ 19 – 21 ]. Regarding economic aspects, RPM bears the potential to be a cost-efficient alternative to regular in-office device interrogations [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial

et al. 2020

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Background Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter-defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort. Methods and results Patients were randomized to RPM (n = 92) or standard in-office-FU (n = 88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3 years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12 months [+ 1.2 vs. + 3.9 points in CTL and RPM group, respectively (p = 0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (− 0.4 vs. − 0.3, p = 0.88), depression (+ 0.3 vs. ± 0.0, p = 0.38), nor device acceptance (+ 1.1 vs. + 1.6, p = 0.20) were influenced by additional use of RPM. Conclusion The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice.

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Section: Discussionmentioning

confidence: 99%

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial

et al. 2020

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“…In practice, however, clinicians may have reservations about remotely assessing their most vulnerable and unwell patients. As described by Geller et al , 21 ‘in clinical practice telemedicine seems to be used mainly in patients with better prognosis, probably due to the belief that those who live longer may receive more (ie, prolonged) benefit from telemonitoring than sicker patients who should be seen in the office more frequently’ (p1124). Consequently, clinicians may require additional information on how RPM can be safely delivered in high-risk cohorts.…”

Section: Resultsmentioning

confidence: 99%

Factors influencing the effectiveness of remote patient monitoring interventions: a realist review

et al. 2021

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ObjectivesOur recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.DesignRealist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an individual’s biometric data (eg, heart rate, blood pressure) from a distance.Primary and secondary outcome measuresContextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).ResultsAcross a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.ConclusionWhile RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.PROSPERO registration numberCRD42020142523.

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“…Eleven RCTs have been conducted. [25][26][27][28][29][30][31][32][33][34][35] Of these, only three demonstrated a significant reduction in acute care use with a reduction in length of hospital stays 26 by 2.5 days (RPM=10.3±8.1 days, median: 8.0 days vs non-monitored group=17.5±19.9 days, median 10.5 days, p=0.027) and lower hospitalisation rates in the monitored group (37.1% vs 45.5%, p=0.045 31 ; hazard ratio (HR) 0.6, 0.42-0.79, p=0.002). 35 All remaining RCTs (n=6, 55%) showed no significant effect.…”

Section: Technologymentioning

confidence: 99%

Does remote patient monitoring reduce acute care use? A systematic review

et al. 2021

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ObjectiveChronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use.MethodsA systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology.ResultsFrom 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring.ConclusionRPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM’s effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients.PROSPERO registration numberCRD42020142523.

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Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial

Cited by 28 publications

References 42 publications

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial

Factors influencing the effectiveness of remote patient monitoring interventions: a realist review

Does remote patient monitoring reduce acute care use? A systematic review

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