Does Remote Monitoring of ICD Patients Lower Risk of Adverse Outcomes?
Remote monitoring for patients receiving an implantable cardioverter defibrillator (ICD) for the first time may be associated with lower mortality and fewer rehospitalizations among older patients, according to a study published in Circulation: Arrhythmia and Electrophysiology.
The study, led by Joseph G. Akar, MD, PhD, of the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine and Center of Outcomes Research and Evaluation at Yale-New Haven Hospital in New Haven, CT, used data from ACC’s ICD Registry and the Boston Scientific ALTITUDE Registry linked with the Social Security Death Master File to determine mortality rates and Centers for Medicare and Medicaid Services’ data for rehospitalization information. The researchers examined records between January 2006 and March 2010 from nearly 38,000 patients who had died and about 15,250 patients 65 or older who were rehospitalized. They compared outcomes for patients being monitored with those who were not.
Results showed that after a median follow-up of 832 days, the one- and three-year mortality rate was 9 percent and 20 percent, respectively, with remote monitoring patients showing a significantly lower risk of mortality. Similar results were found during a landmark analysis, measured at 60, 90, and 180 days.
The three-year rehospitalization rate among all 15,250 patients was 69 percent, with a median follow-up of 922 days. Among these patients, the remote patient monitoring group was hospitalized less frequently, and the patients who appeared to benefit the most were white, had a weakened heart muscle not associated with coronary artery disease, and were receiving an ICD for primary prevention. In analyses at 60, 90, and 189 days, the remote patient monitoring group showed modestly lower rates of rehospitalization compared with the non-remote patient monitoring group.
The authors conclude that although remote patient monitoring technology is widely available, it is underutilized. Further, their findings provide evidence in support of more widespread use of this potentially life-saving tool.
“There is a pressing need to understand how to efficiently and effectively incorporate remote patient monitoring into clinical practice,” the authors explain. “Although many providers routinely use remote patient monitoring, insights into the organizational strategies and enabling structures that promote the successful integration into clinical practice have not been identified and shared broadly across the community of implanting physicians.” They add that this information would be beneficial because “the weight of the available evidence justifies strong consideration of its routine use in clinical practice.”
Keywords: Arrhythmias, Cardiac, Centers for Medicare and Medicaid Services, U.S., Coronary Artery Disease, Defibrillators, Implantable, Electrophysiology, Medicaid, Medicare, Monitoring, Physiologic, Myocardium, Outcome Assessment, Health Care, Primary Prevention, National Cardiovascular Data Registries, ICD Registry
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