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Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators: Insights From the Patient Related Determinants of ICD Remote Monitoring (PREDICt RM) Study
Study Questions:
How often is remote patient monitoring (RPM) used in patients with implantable cardioverter-defibrillators (ICDs)?
Methods:
Data for this study were obtained from a Boston Scientific Corporation database and linked to the National Cardiovascular Data Registry (NCDR) ICD registry. A RPM-capable ICD was implanted in 39,158 patients at 883 hospitals. RPM enrollment and activation were noted for every patient. Multiple variables were analyzed to identify predictors of RPM enrollment and activation.
Results:
Sixty-two percent of patients were enrolled in RPM. Among the RPM-enrolled patients, 76% of patients activated the RPM. Therefore, the overall RPM utilization rate was 47%. The independent predictors of nonenrollment in RPM included nonwhite ethnicity, Medicaid or no insurance, residency in an urban area, and electrophysiology board certification of the device implanter. The strongest predictor of RPM enrollment was the hospital in which the ICD was implanted, with a 3.4-fold difference in the odds of enrollment among the hospitals. The predictors of RPM activation were the same patient characteristics associated with enrollment. Physician- and hospital-related factors were less important predictors of RPM enrollment than activation.
Conclusions:
The authors concluded that RPM is utilized in fewer than 50% of patients receiving a RPM-capable ICD. Underutilization is attributable mostly to failure to enroll patients.
Perspective:
An advantage of RPM is that it replaces the need for many of the in-person clinic visits usually required post-ICD implantation. In addition, RPM allows for ongoing assessment of device parameters such as battery status and lead impedance, resulting in earlier detection of device or lead malfunction. The results of this study suggest that hospital-related factors should be the focus of attention when attempting to improve the RPM utilization rate.
Keywords: Hospitals, Defibrillators, Early Diagnosis, Boston
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