Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators

Citation:

Joseph G Akar, Haikun Bao, Paul W Jones, Yongfei Wang, Paul D Varosy, Frederick A Masoudi, Kenneth M Stein, Leslie A Saxon, Sharon-Lise T Normand, and Jeptha P Curtis. 2015. “Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators.” Circ Arrhythm Electrophysiol, 8, 5, Pp. 1173-80.

Abstract:

BACKGROUND: We examined the association between the use of remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICD) and all-cause mortality and rehospitalization among patients undergoing initial ICD implant. METHODS AND RESULTS: A limited data set was constructed from Boston Scientific ALTITUDE Registry and National Cardiovascular Data Registry ICD Registry between January 2006 and March 2010. Vital status was determined using the Social Security Death Master File. All-cause mortality up to 3 years was compared in patients who used RPM with those who did not use RPM. Time-dependent frailty Cox models quantified the association between RPM use and all-cause mortality. Analyses were repeated in subgroups based on age, sex, race, ICD type, indication, and cardiomyopathy pathogenesis. Similar methodology examined the association between RPM use and all-cause rehospitalization in patients enrolled in Medicare fee-for-service patients ≥65 years. The study cohort (n=37,742, age 67±13, 72% male) had a 3-year mortality of 20.9% (median follow-up 832 days). In multivariable analyses, patients using RPM (n=22,023, 58%) had lower risk of mortality compared with those not using RPM (hazard ratio 0.67, 95% confidence interval 0.64-0.71, P<0.0001). The 3-year all-cause rehospitalization rate in the Medicare population (n=15,254) was 69.3% (median follow-up 922 days). Risk of rehospitalization of patients using RPM (n=9150, 60%) was lower than those not using RPM (hazard ratio 0.82, 95% confidence interval 0.80-0.84, P<0.0001). Findings were consistent across subgroups. CONCLUSIONS: Among patients undergoing initial ICD implant, RPM use is associated with significantly lower risk of adverse outcomes.