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The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial: The Value of Wireless Remote Monitoring With Automatic Clinician Alerts
Study Questions:
What is the effect of wireless remote monitoring with automatic clinician alerts on time from a clinical event to a clinical decision in response to arrhythmias, cardiovascular (CV) disease progression, and device issues compared to patients receiving standard in-office care?
Methods:
The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) study was a multicenter, prospective, randomized evaluation involving 1,997 patients from 136 clinical sites who underwent insertion of an implantable cardioverter-defibrillator (including cardiac resynchronization therapy devices) and were followed up for 15 months. Health care utilization data included all CV-related hospitalizations, emergency department visits, and clinic office visits.
Results:
The median time from clinical event to clinical decision per patient was reduced from 22 days in the in-office arm to 4.6 days in the remote arm (p = 0.001). The health care utilization data revealed a decrease in mean length of stay per CV hospitalization visit from 4.0 days in the in-office arm to 3.3 days in the remote arm (p = 0.002).
Conclusions:
The authors concluded that wireless remote monitoring with automatic clinician alerts, as compared with standard in-office follow-up, significantly reduced the time to a clinical decision in response to clinical events.
Perspective:
The study suggests that wireless remote monitoring with automatic clinician alerts, as compared with standard in-office follow-up, significantly reduces the time to a clinical decision in response to clinical events, and is associated with a significant reduction in mean hospital length of stay. It appears that clinics employing wireless remote monitoring may expect fewer total clinic visits per year while not increasing the rate of emergency department visits or CV hospitalizations for their patients. Overall, better deployment and utilization of the wireless remote monitoring system may result in more timely treatment decisions and improved patient outcomes.
Keywords: Cardiac Resynchronization Therapy Devices, Follow-Up Studies, Cardiology, Emergency Service, Hospital, Hospitalization, Office Visits, Defibrillators, Implantable, Disease Progression
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