Perspective:

Remote home monitoring has evolved over the course of several decades, from a simple transtelephonic monitoring using a magnet rate to predict battery depletion, to daily wireless transmission of comprehensive device data, which does not require active patient involvement (the transceiver is in the bedroom and it automatically transmits data to the server when alerts are triggered). RM captured interest in the early and mid 2000s following the publication of primary prevention studies expanding the indications for ICD therapy and amid a series of Food and Drug Administration advisories, all of which were expected to overwhelm device clinic capacity. Given that about 90% of in-person device clinic appointments are not actionable encounters (i.e., there is no need to reprogram the device in response to the observed interrogation data), RM has become an efficient way to monitor a large number of patients with devices. The RM system in the present study is an older version, which relied on weekly patient activation. While causal relationship between frequent monitoring and survival cannot be inferred from the current observational study, the findings are consistent with other studies in this field, with some notable exceptions of small randomized studies, which may have been underpowered to demonstrate survival benefit. The most notable finding, however, is the fact that even patients with pacemakers, who are at a lower risk of adverse events than ICD or CRT-D patients, still appear to derive survival benefit from the monitoring. It is possible that early identification of device malfunction, the onset of asymptomatic atrial fibrillation, and new or increasing burden of ventricular arrhythmias may be responsible for this benefit. Due to relatively favorable reimbursement rates for RM, there is a growing cohort of device patients followed by general cardiologists rather than electrophysiologists, regardless of who has implanted the device. It would be interesting to explore whether there is a relationship between the primary specialty of the physician responsible for RM, adherence to RM, and patient survival.