BOSTON—Remote monitoring reduced unplanned hospital admissions and in general total healthcare utilization in patients with implantable cardioverter-defibrillators (ICDs), according to results presented May 10 at the 2012 Heart Rhythm Society's annual scientific sessions..
Giovanni B. Perego, MD, from the division of cardiologyat Ospedale San Luca, Istituto Auxlogico Italiano IRCCS in Milan, Italy, and colleagues conducted a multicenter randomized trial involving 200 patients for a 16-month follow-up and compared remote monitoring with standard patient management. Standard management consisted of scheduled visits and patient responses to audible ICD alerts.
“Heart failure patients with implantable defibrillators (ICD) often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers,” the authors wrote. Internet-based remote interrogation systems are being proposed to reduce these visits, as well as to promptly detect and notify alert conditions.
“The ability of implantable devices to continuously monitor variables such as heart rate, a patient’s daily activity, intra-thoracic impedance for the detection of fluid accumulation, the occurrence of arrhythmias and the integrity of the system may provide early warning of changes in cardiac status or of safety issues and allow timely management,” said Perego in an interview.
If those patients have a clinical event such as ICD shock or device audible alert notifications, they usually visit the emergency department (ED) or ask for an unscheduled visit, according to Perego. While the features of an ICD provide information and alerts oriented to disease management, not all these visits turn out to be necessary. That may result in extra costs for emergency assistance and the effort to organize timely in-office visits, he added.
He and colleagues hypothesized that remote monitoring could reduce emergency admissions in heart failure patients implanted with ICDs or endowed with diagnostic features for heart failure.
The rate of cardiac or device-related unplanned emergency department or in-hospital visits was reduced by 36 percent in the remote arm (75 vs. 117), the authors found. There was a 23 percent reduction in the rates of all hospital admissions (planned and unplanned) for cardiac or device-related events (4.4 vs. 5.74 events/year).
Additionally, the time from an ICD alert condition to the data review was 24.8 days in the standard arm and 1.4 days in the remote arm. “The patient's clinical status, measured by the Clinical Composite Score, was similar in the two groups, while a more favorable change in quality of life (Minnesota Living with Heart Failure Questionnaire) was observed from the baseline to the 16-month follow-up in the remote arm,” the authors wrote.
Compared with standard follow-up of in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for the patients, they concluded.
The study’s expectations were met, Perego said. “We expected remote management of this bulk of information would allow the clinician to distinguish between relevant and non-relevant alerts. Devices with complex diagnostic features oriented to the disease management of heart failure patients, can improve the quality (effectiveness and efficiency) of care only if remotely controlled.”
He acknowledged the limitation that their results cannot be extended to devices having different diagnostic features. Moving forward, Perego stated it is time to demonstrate the impact of devices' remote monitoring on prognosis.