A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort

• Published in: Revista portuguesa de cardiologia 2017-03, Vol.36 (3), p.189-195
• Main Authors: Portugal, Guilherme, Cunha, Pedro, Valente, Bruno, Feliciano, Joana, Lousinha, Ana, Alves, Sandra, Braz, Manuel, Pimenta, Ricardo, Delgado, Ana Sofia, Oliveira, Mário, Ferreira, Rui C.
• Format: Article
• Language: English
• Subjects: Cardioversor-desfibrilhador implantável; Cohort Studies; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - adverse effects; Defibrillators, Implantable - standards; Female; Heart failure; Humans; Implantable cardioverter-defibrillator; Insuficiência cardíaca; Male; Middle Aged; Monitorização remota; Patient Admission - statistics & numerical data; Propensity Score; Quality Improvement; Remote monitoring; Remote Sensing Technology; Retrospective Studies; Time Factors
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2016.08.009

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). 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. 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). 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. Existem dados contraditórios acerca dos benefícios clínicos da monitorização remota (MR). Os autores procuraram aferir o efeito da MR de dispositivos cardíacos implantáveis em eventos clínicos a longo prazo. Os autores avaliaram a incidência de eventos cardíacos adversos, mortalidade global, e a eficácia e segurança das terapêuticas entregues pelo dispositivo numa amostra de pacientes portadores de cardioversor-desfibrilhador implantável (CDI) após emparelhamento por propensity score, comparando doentes sob MR com doentes em seguimento convencional. Dados relativos a hospitalizações, mortalidade e causa de morte foram sistematicamente avaliados com recurso à Plataforma de Dados de Saúde. A análise primária consistiu no tempo até um evento composto de internamento por insuficiência cardíaca (IC) ou morte cardiovascular. Num total de 923 portadores de disposit