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Clinical Impact of Remote Monitoring in ICD Patients | Journal Scan
Study Questions:
Does a systematic literature review confirm a survival advantage for patients undergoing remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs)?
Methods:
The authors searched electronic databases for randomized controlled studies (RCTs) reporting clinical outcomes in ICD patients who did or did not undergo RM.
Results:
The authors identified nine RCTs, which comprised 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to in-office (IO) follow-up. Patients undergoing RM and IO had similar all-cause mortality (odds ratio [OR], 0.83; p = 0.285), cardiovascular mortality (OR, 0.66; p = 0.103), and hospitalization (OR, 0.83; p = 0.196). However, the three trials utilizing home monitoring with daily verification of transmission showed a significant decease in all-cause mortality (OR, 0.65; p = 0.021). While the odds of receiving any ICD shock were similar in RM and IO patients (OR, 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR, 0.55; p = 0.002).
Conclusions:
According to the meta-analysis, RM and IO follow-up showed comparable survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
Perspective:
RM of ICD patients has become a standard in many cardiology practices. Yet, it is estimated that RM is not utilized in as many as 50% of eligible patients. Various prior studies showed reductions in hospital and resource utilization, and improvements in follow-up adherence. Studies, which examined the role of daily RM, showed improved survival in the monitored patients. It would be helpful to investigate the impediments that prevent RM in order to improve utilization of this, in all likelihood, beneficial clinical tool.
Keywords: Arrhythmias, Cardiac, Defibrillators, Implantable, Follow-Up Studies, Heart Conduction System, Heart Failure, Hospitalization, Hospitals, Monitoring, Physiologic, Mortality, Shock, Survival
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