Remote monitoring data from cardiac implantable electronic devices predicts all-cause mortality

Abstract

Aims To determine if remotely monitored physiological data from cardiac implantable electronic devices (CIEDs) can be used to identify patients at high risk of mortality. Methods and results This study evaluated whether a risk score based on CIED physiological data (Triage-Heart Failure Risk Status, ‘Triage-HFRS’, previously validated to predict heart failure (HF) events) can identify patients at high risk of death. Four hundred and thirty-nine adults with CIEDs were prospectively enrolled. Primary observed outcome was all-cause mortality (median follow-up: 702 days). Several physiological parameters [including heart rate profile, atrial fibrillation/tachycardia (AF/AT) burden, ventricular rate during AT/AF, physical activity, thoracic impedance, therapies for ventricular tachycardia/fibrillation] were continuously monitored by CIEDs and dynamically combined to produce a Triage-HFRS every 24 h. According to transmissions patients were categorized into ‘high-risk’ or ‘never high-risk’ groups. During follow-up, 285 patients (65%) had a high-risk episode and 60 patients (14%) died (50 in high-risk group; 10 in never high-risk group). Significantly more cardiovascular deaths were observed in the high-risk group, with mortality rates across groups of high vs. never-high 10.3% vs. <4.0%; P = 0.03. Experiencing any high-risk episode was associated with a substantially increased risk of death [odds ratio (OR): 3.07, 95% confidence interval (CI): 1.57–6.58, P = 0.002]. Furthermore, each high-risk episode ≥14 consecutive days was associated with increased odds of death (OR: 1.26, 95% CI: 1.06–1.48; P = 0.006). Conclusion Remote monitoring data from CIEDs can be used to identify patients at higher risk of all-cause mortality as well as HF events. Distinct from other prognostic scores, this approach is automated and continuously updated.

Remote Monitoring of CIEDs—For Both Safety, Economy and Convenience?

“…Remote monitoring can deliver information from an enormous number of patients and provide the scientific community with important data regarding arrhythmias, heart failure, sudden cardiac death, and all-cause mortality. This has been described in several studies [ 26 , 27 , 28 , 29 , 30 ] and also discussed in previous reviews [ 31 ].…”

European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…LGE-CMR), 68 monitoring (e.g. remote monitoring) 69 or therapeutic (e.g. ablation) 62 technologies for patients at risk of SCD.…”

Clinical Pathways Guided by Remotely Monitoring Cardiac Device Data: The Future of Device Heart Failure Management?

“…Spending ≥1 day in a high-risk status was associated with a 3.07 increase in the odds risk of death (95% CI [1.57-6.58]; p=0.002), with a correlation observed between the number of days in a high-risk status and the risk of death. 68 Zile et al reported that 4-year all-cause mortality rates for high-and low-risk status patients (maximum score within the first 6 months of score initialisation) was 38% and 14%, respectively. 66 The TriageHF risk status has been tested in combination with a clinical pathway in various small-scale clinical studies.…”