A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort.
AIMS
There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs).


METHODS
We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death.


RESULTS
Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS).


CONCLUSION
In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death.
['Portugal|Guilherme|G|', 'Cunha|Pedro|P|', 'Valente|Bruno|B|', 'Feliciano|Joana|J|', 'Lousinha|Ana|A|', 'Alves|Sandra|S|', 'Braz|Manuel|M|', 'Pimenta|Ricardo|R|', 'Delgado|Ana Sofia|AS|', 'Oliveira|Mário|M|', 'Ferreira|Rui C|RC|']
D015331:Cohort Studies D016757:Death, Sudden, Cardiac D017147:Defibrillators, Implantable D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010343:Patient Admission D057216:Propensity Score D058996:Quality Improvement D058998:Remote Sensing Technology D012189:Retrospective Studies D013997:Time Factors
Remote monitoring Implantable cardioverter-defibrillator Heart failure Cardioversor-desfibrilhador implantável Insuficiência cardíaca Monitorização remota