Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis

• Published in: Canadian journal of cardiology 2022-06, Vol.38 (6), p.736-744
• Main Authors: Chew, Derek S., Zarrabi, Mahmood, You, Isabelle, Morton, James, Low, Aaron, Reyes, Lucy, Yuen, Brian, Sumner, Glen L., Raj, Satish R., Exner, Derek V., Wilton, Stephen B.
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2022.01.022

Despite expert recommendations advocating use of remote monitoring (RM) of cardiac implantable electronic devices, implementation in routine clinical practice remains modest due to inconsistent funding policies across health systems and uncertainty regarding the efficacy of RM to reduce adverse cardiovascular outcomes. We conducted a population-based cohort study of patients with de novo implantable cardioverter-defibrillators (ICDs) with or without cardiac resynchronization therapy (CRT-D), using administrative health data in Alberta, Canada, from 2010 to 2016. We assessed RM status as a predictor of all-cause mortality and cardiovascular (CV) hospitalization using Cox proportional hazards modelling, and direct health costs by generalized linear models. From this real-world data, we then constructed a decision-analytic Markov model to estimate the projected costs and benefits associated with RM compared with in-clinic visit follow-up alone. Among 2799 ICD and CRT-D patients, 1830 (63.4%) were followed by RM for a mean follow-up of 50.3 months. After adjustment for age, sex, and comorbidities, RM was associated with a lower risk of death (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.36-0.52; P < 0.001) and CV hospitalization (HR 0.76, 95% CI 0.64-0.91; P = 0.002). In the economic model, cost savings were observed over 5 years with an estimated savings of $12,195 per person (95% CI −$21,818 to −$4,790). The model estimated a cost-savings associated with RM strategy in 99% of simulations. These population data support more widespread implementation of RM technology to facilitate better patient outcomes and improve health system efficiency. Malgré les recommandations d'experts préconisant l'utilisation de la télésurveillance (TS) des dispositifs électroniques cardiaques implantables, la mise en œuvre dans la pratique clinique courante reste limitée en raison de politiques de financement inégales entre les divers systèmes de santé et de l'incertitude quant à l'efficacité de la TS à réduire les conséquences cardiovasculaires indésirables. Nous avons mené une étude de cohorte basée sur une population de patients avec des défibrillateurs cardioverteurs implantables (DCI) de novo, avec ou sans thérapie de resynchronisation cardiaque (TRC-D), en utilisant les données administratives de santé en Alberta, Canada, de 2010 à 2016. Nous avons évalué le statut de la TS comme prédicteur de la mortalité toutes causes confondues et des hospitalisations cardiovascu