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Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study
Introduction A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However...
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| Published in: | Journal of telemedicine and telecare 2016-10, Vol.22 (7), p.383-390 |
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| Main Authors: | , , , , , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c398t-ce715a29542fd25f575cb7ea0791b87543039d3aa813070b05ca3890a052a1b33 |
| container_end_page | 390 |
| container_issue | 7 |
| container_start_page | 383 |
| container_title | Journal of telemedicine and telecare |
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| creator | D’Onofrio, Antonio Stabile, Giuseppe Capucci, Alessandro Amellone, Claudia De Simone, Antonio Leoni, Loira Morani, Giovanni Bianchi, Valter Campari, Monica Valsecchi, Sergio Buja, Gianfranco |
| description | Introduction
A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months.
Methods
Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients.
Results
The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p |
| doi_str_mv | 10.1177/1357633X15613701 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1845814643</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1357633X15613701</sage_id><sourcerecordid>1845814643</sourcerecordid><originalsourceid>FETCH-LOGICAL-c398t-ce715a29542fd25f575cb7ea0791b87543039d3aa813070b05ca3890a052a1b33</originalsourceid><addsrcrecordid>eNqNkcFu1DAQhiNERUvhzglZ4sIldMaO1wm31WoXkCr1UiRuke1MiksSL7YDWp6Bh8ZhC5UqIXEaW_PNZ4_-oniB8AZRqQsUUq2E-IRyhUIBPirOUMm6RITmcT7ndrn0T4unMd4CcKxk86Q45SsFIl_Oip_rGL11Ojk_MUPpO9HEAo0-EXPjftBT0mYgZnXonP9GIVFgHfXOBDcMOvnARj-5XN10w_TULRJdmsHbL5mckxvcj9_2t2w9ZUAPh-gi64MfWfpMbLvbbTfXLKa5OzwrTno9RHp-V8-Lj7vt9eZ9eXn17sNmfVla0dSptKRQat7Iivcdl71U0hpFGlSDplayEiCaTmhdowAFBqTVom5Ag-QajRDnxeujdx_815liakcXLeV9JvJzbLGuZI3VqvoflPNKQYUL-uoBeuvnkBeOLecAjczfWig4Ujb4GAP17T64UYdDi9AuobYPQ80jL-_Esxmp-zvwJ8UMlEcg6hu6f_Wfwl96Qqn6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2200953033</pqid></control><display><type>article</type><title>Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study</title><source>Sage Journals Online</source><creator>D’Onofrio, Antonio ; Stabile, Giuseppe ; Capucci, Alessandro ; Amellone, Claudia ; De Simone, Antonio ; Leoni, Loira ; Morani, Giovanni ; Bianchi, Valter ; Campari, Monica ; Valsecchi, Sergio ; Buja, Gianfranco</creator><creatorcontrib>D’Onofrio, Antonio ; Stabile, Giuseppe ; Capucci, Alessandro ; Amellone, Claudia ; De Simone, Antonio ; Leoni, Loira ; Morani, Giovanni ; Bianchi, Valter ; Campari, Monica ; Valsecchi, Sergio ; Buja, Gianfranco ; EFFECT study investigators</creatorcontrib><description>Introduction
A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months.
Methods
Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients.
Results
The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM (p = 0.003) and the achievement of the effective dose of beta-blockers (p = 0.006) were independently and positively associated with an improved outcome.
Discussion
In a ‘real-world’ setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.</description><identifier>ISSN: 1357-633X</identifier><identifier>EISSN: 1758-1109</identifier><identifier>DOI: 10.1177/1357633X15613701</identifier><identifier>PMID: 26703214</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adrenergic beta-Antagonists - administration & dosage ; Adrenergic beta-Antagonists - therapeutic use ; Aged ; Beta blockers ; Bisoprolol - administration & dosage ; Bisoprolol - therapeutic use ; Carbazoles - administration & dosage ; Carbazoles - therapeutic use ; Defibrillators ; Defibrillators, Implantable ; Female ; Humans ; Impact analysis ; Male ; Medication Adherence ; Monitoring, Ambulatory - methods ; Patients ; Propanolamines - administration & dosage ; Propanolamines - therapeutic use ; Prospective Studies ; Receiving ; Remote monitoring ; Telecare ; Telemedicine ; Transplants & implants ; Treatment Outcome</subject><ispartof>Journal of telemedicine and telecare, 2016-10, Vol.22 (7), p.383-390</ispartof><rights>The Author(s) 2015</rights><rights>The Author(s) 2015.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-ce715a29542fd25f575cb7ea0791b87543039d3aa813070b05ca3890a052a1b33</citedby><cites>FETCH-LOGICAL-c398t-ce715a29542fd25f575cb7ea0791b87543039d3aa813070b05ca3890a052a1b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,79364</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26703214$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D’Onofrio, Antonio</creatorcontrib><creatorcontrib>Stabile, Giuseppe</creatorcontrib><creatorcontrib>Capucci, Alessandro</creatorcontrib><creatorcontrib>Amellone, Claudia</creatorcontrib><creatorcontrib>De Simone, Antonio</creatorcontrib><creatorcontrib>Leoni, Loira</creatorcontrib><creatorcontrib>Morani, Giovanni</creatorcontrib><creatorcontrib>Bianchi, Valter</creatorcontrib><creatorcontrib>Campari, Monica</creatorcontrib><creatorcontrib>Valsecchi, Sergio</creatorcontrib><creatorcontrib>Buja, Gianfranco</creatorcontrib><creatorcontrib>EFFECT study investigators</creatorcontrib><title>Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study</title><title>Journal of telemedicine and telecare</title><addtitle>J Telemed Telecare</addtitle><description>Introduction
A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months.
Methods
Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients.
Results
The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM (p = 0.003) and the achievement of the effective dose of beta-blockers (p = 0.006) were independently and positively associated with an improved outcome.
Discussion
In a ‘real-world’ setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.</description><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Aged</subject><subject>Beta blockers</subject><subject>Bisoprolol - administration & dosage</subject><subject>Bisoprolol - therapeutic use</subject><subject>Carbazoles - administration & dosage</subject><subject>Carbazoles - therapeutic use</subject><subject>Defibrillators</subject><subject>Defibrillators, Implantable</subject><subject>Female</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Monitoring, Ambulatory - methods</subject><subject>Patients</subject><subject>Propanolamines - administration & dosage</subject><subject>Propanolamines - therapeutic use</subject><subject>Prospective Studies</subject><subject>Receiving</subject><subject>Remote monitoring</subject><subject>Telecare</subject><subject>Telemedicine</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><issn>1357-633X</issn><issn>1758-1109</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNkcFu1DAQhiNERUvhzglZ4sIldMaO1wm31WoXkCr1UiRuke1MiksSL7YDWp6Bh8ZhC5UqIXEaW_PNZ4_-oniB8AZRqQsUUq2E-IRyhUIBPirOUMm6RITmcT7ndrn0T4unMd4CcKxk86Q45SsFIl_Oip_rGL11Ojk_MUPpO9HEAo0-EXPjftBT0mYgZnXonP9GIVFgHfXOBDcMOvnARj-5XN10w_TULRJdmsHbL5mckxvcj9_2t2w9ZUAPh-gi64MfWfpMbLvbbTfXLKa5OzwrTno9RHp-V8-Lj7vt9eZ9eXn17sNmfVla0dSptKRQat7Iivcdl71U0hpFGlSDplayEiCaTmhdowAFBqTVom5Ag-QajRDnxeujdx_815liakcXLeV9JvJzbLGuZI3VqvoflPNKQYUL-uoBeuvnkBeOLecAjczfWig4Ujb4GAP17T64UYdDi9AuobYPQ80jL-_Esxmp-zvwJ8UMlEcg6hu6f_Wfwl96Qqn6</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>D’Onofrio, Antonio</creator><creator>Stabile, Giuseppe</creator><creator>Capucci, Alessandro</creator><creator>Amellone, Claudia</creator><creator>De Simone, Antonio</creator><creator>Leoni, Loira</creator><creator>Morani, Giovanni</creator><creator>Bianchi, Valter</creator><creator>Campari, Monica</creator><creator>Valsecchi, Sergio</creator><creator>Buja, Gianfranco</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>7U5</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>L7M</scope></search><sort><creationdate>201610</creationdate><title>Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study</title><author>D’Onofrio, Antonio ; Stabile, Giuseppe ; Capucci, Alessandro ; Amellone, Claudia ; De Simone, Antonio ; Leoni, Loira ; Morani, Giovanni ; Bianchi, Valter ; Campari, Monica ; Valsecchi, Sergio ; Buja, Gianfranco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-ce715a29542fd25f575cb7ea0791b87543039d3aa813070b05ca3890a052a1b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Aged</topic><topic>Beta blockers</topic><topic>Bisoprolol - administration & dosage</topic><topic>Bisoprolol - therapeutic use</topic><topic>Carbazoles - administration & dosage</topic><topic>Carbazoles - therapeutic use</topic><topic>Defibrillators</topic><topic>Defibrillators, Implantable</topic><topic>Female</topic><topic>Humans</topic><topic>Impact analysis</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Monitoring, Ambulatory - methods</topic><topic>Patients</topic><topic>Propanolamines - administration & dosage</topic><topic>Propanolamines - therapeutic use</topic><topic>Prospective Studies</topic><topic>Receiving</topic><topic>Remote monitoring</topic><topic>Telecare</topic><topic>Telemedicine</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D’Onofrio, Antonio</creatorcontrib><creatorcontrib>Stabile, Giuseppe</creatorcontrib><creatorcontrib>Capucci, Alessandro</creatorcontrib><creatorcontrib>Amellone, Claudia</creatorcontrib><creatorcontrib>De Simone, Antonio</creatorcontrib><creatorcontrib>Leoni, Loira</creatorcontrib><creatorcontrib>Morani, Giovanni</creatorcontrib><creatorcontrib>Bianchi, Valter</creatorcontrib><creatorcontrib>Campari, Monica</creatorcontrib><creatorcontrib>Valsecchi, Sergio</creatorcontrib><creatorcontrib>Buja, Gianfranco</creatorcontrib><creatorcontrib>EFFECT study investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>Advanced Technologies Database with Aerospace</collection><jtitle>Journal of telemedicine and telecare</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D’Onofrio, Antonio</au><au>Stabile, Giuseppe</au><au>Capucci, Alessandro</au><au>Amellone, Claudia</au><au>De Simone, Antonio</au><au>Leoni, Loira</au><au>Morani, Giovanni</au><au>Bianchi, Valter</au><au>Campari, Monica</au><au>Valsecchi, Sergio</au><au>Buja, Gianfranco</au><aucorp>EFFECT study investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study</atitle><jtitle>Journal of telemedicine and telecare</jtitle><addtitle>J Telemed Telecare</addtitle><date>2016-10</date><risdate>2016</risdate><volume>22</volume><issue>7</issue><spage>383</spage><epage>390</epage><pages>383-390</pages><issn>1357-633X</issn><eissn>1758-1109</eissn><abstract>Introduction
A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months.
Methods
Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients.
Results
The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM (p = 0.003) and the achievement of the effective dose of beta-blockers (p = 0.006) were independently and positively associated with an improved outcome.
Discussion
In a ‘real-world’ setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>26703214</pmid><doi>10.1177/1357633X15613701</doi><tpages>8</tpages></addata></record> |
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| subjects | Adrenergic beta-Antagonists - administration & dosage Adrenergic beta-Antagonists - therapeutic use Aged Beta blockers Bisoprolol - administration & dosage Bisoprolol - therapeutic use Carbazoles - administration & dosage Carbazoles - therapeutic use Defibrillators Defibrillators, Implantable Female Humans Impact analysis Male Medication Adherence Monitoring, Ambulatory - methods Patients Propanolamines - administration & dosage Propanolamines - therapeutic use Prospective Studies Receiving Remote monitoring Telecare Telemedicine Transplants & implants Treatment Outcome |
| title | Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study |
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