Remote monitoring of implantable cardioverter-defibrillators and resynchronization devices to improve patient outcomes: dead end or way ahead?

Abstract

Remote monitoring (RM) has become a new standard of care in the follow-up of patients with implantable pacemakers and defibrillators. While it has been consistently shown that RM enables earlier detection of clinically actionable events compared with traditional in-patient evaluation, this advantage did not translate into improved patient outcomes in clinical trials of RM except one study using daily multiparameter telemonitoring in heart failure (HF) patients. Therefore, this review, focusing on RM studies of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators in patients with HF, discusses possible explanations for the differences in trial outcomes. Patient selection may play an important role as more severe HF and concomitant atrial fibrillation have been associated with improved outcomes by RM. Furthermore, the technical set-up of RM may have an important impact as a higher level of connectivity with more frequent data transmission can be linked to better outcomes. Finally, there is growing evidence as to the need of effective algorithms ensuring a fast and well-structured clinical response to the events detected by RM. These factors re-emphasize the potential of remote management of device patients with HF and call for continued clinical research and technical development in the field.

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

“…However, in the last decade the new generation of ICD devices that supports wireless technology has enabled remote monitoring of the device [ 3 - 6 ]. Consequently, in order to improve clinical practice of ICD follow-ups and to provide earlier detection of clinical problems, a wider use of remote patient monitoring (RPM) has been recommended by scientific associations in both Europe [ 5 ] and the United States [ 7 ], and has become the new standard of care for patient follow-up [ 8 - 10 ]. When a patient is remotely followed, the office-based visits can be limited to the initial postimplantation period and annual follow-ups, unless alerts or the patient’s health requires an urgent in-person check [ 6 ].…”

Cardiac Resynchronization Therapy Remote Monitoring – COVID-19 Pandemic Experiences and Future Perspectives

“…The role of remote monitoring in CRT and other cardiac implantable electronic devices (CIED) – implantable cardioverter-defibrillators (ICD) and pacemakers (PM) has been pointed out in numerous papers 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 . It has positive impact on patients’ quality of life, healthcare costs reduction and, what is the most important, clinical outcome of HF patients 5 , 6 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 .…”

Challenges in the remote monitoring of cardiac implantable electronic devices in 2021

“…Revisiting in the future such a telephone based approach to remote monitoring would require a substantial implementation of novel technologies. It is also of great importance for the CIED clinic to have a structured pathway to react to alarms or events detected via RM, as this may influence patient outcomes [19,20]. In a recently published analysis of the results of the Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™ (OptiLink HF) study, for example, RM appropriate reactions to intrathoracic fluid index threshold crossings alerts were associated with significantly improved clinical outcomes in patients with advanced HF.…”

“…Reduced ejection fraction [12,13], chronic renal failure [14], arrhythmogenic right ventricular cardiomyopathy [15,16], Brugada syndrome [17,18] and dilated-hypertrophic cardiomyopathy [11] have been reported as risk factors for critical events. Other studies demonstrated that RM may improve outcomes in patients with severe heart failure and atrial fibrillation [19,20]. An analysis of the FOLLOWPACE study [21] evaluated different patient-and procedure-related characteristics to identify subjects at high risk of complication following pacemaker implantation.…”