Remote monitoring of patients with implantable cardioverter-defibrillators: can results from large clinical trials be transposed to clinical practice?
BACKGROUND
Remote monitoring (RM) is increasingly used to follow up patients with implantable cardioverter-defibrillators (ICDs). Randomized control trials provide evidence for the benefit of this intervention, but data for RM in daily clinical practice with multiple-brands and unselected patients is lacking.


AIMS
To assess the effect of RM on patient management and clinical outcome for recipients of ICDs in daily practice.


METHODS
We reviewed ICD recipients followed up at our institution in 2009 with RM or with traditional hospital only (HO) follow-up. We looked at the effect of RM on the number of scheduled ambulatory follow-ups and urgent unscheduled consultations, the time between onset of asymptomatic events to clinical intervention and the clinical effectiveness of all consultations. We also evaluated the proportion of RM notifications representing clinically relevant situations.


RESULTS
We included 355 patients retrospectively (RM: n=144, HO: n=211, 76.9% male, 60.3±15.2 years old, 50.1% with ICDs for primary prevention and mean left ventricular ejection fraction 35.5±14.5%). Average follow-up was 13.5 months. The RM group required less scheduled ambulatory follow-up consultations (1.8 vs. 2.1/patient/year; P<0.0001) and a far lower median time between the onset of asymptomatic events and clinical intervention (7 vs. 76 days; P=0.016). Of the 784 scheduled ambulatory follow-up consultations carried out, only 152 (19.4%) resulted in therapeutic intervention or ICD reprogramming. We also found that the vast majority of RM notifications (61.9%) were of no clinical relevance.


CONCLUSION
RM allows early management of asymptomatic events and a reduction in scheduled ambulatory follow-up consultations in daily clinical practice, without compromising safety, endorsing RM as the new standard of care for ICD recipients.
['Morichau-Beauchant|Tristan|T|', 'Boulé|Stéphane|S|', 'Guédon-Moreau|Laurence|L|', 'Finat|Loïc|L|', 'Botcherby|Edward J|EJ|', 'Périer|Marie-Cécile|MC|', 'Salleron|Julia|J|', 'Guibout|Catherine|C|', 'Marquié|Christelle|C|', 'Klug|Didier|D|', 'Kouakam|Claude|C|', 'Wissocque|Ludivine|L|', 'Brigadeau|François|F|', 'Lacroix|Dominique|D|', 'Kacet|Salem|S|']
D000328:Adult D000368:Aged D000553:Ambulatory Care D001145:Arrhythmias, Cardiac D016757:Death, Sudden, Cardiac D017147:Defibrillators, Implantable D004554:Electric Countershock D019317:Evidence-Based Medicine D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011322:Primary Prevention D016032:Randomized Controlled Trials as Topic D012017:Referral and Consultation D012189:Retrospective Studies D013318:Stroke Volume D017216:Telemedicine D013686:Telemetry D013997:Time Factors D016896:Treatment Outcome D016277:Ventricular Function, Left
Remote monitoring Implantable cardioverter-defibrillator Follow-up Defibrillators Défibrillateur automatique implantable Suivi Telemedicine Télécardiologie Télésurveillance