Does wireless remote monitoring with automatic clinician alerts reduce the time from a clinical event to a clinical decision in patients with implantable cardioverter-defibrillators compared to standard in-office care?
Wireless remote monitoring with automatic alerts for ICD/CRT patients significantly reduces the time to clinical decision-making and decreases the length of cardiovascular hospital stays compared to standard in-office follow-up.
OBJECTIVES The primary objective was to determine if wireless remote monitoring with automatic clinician alerts reduces the time from a clinical event to a clinical decision in response to arrhythmias, cardiovascular (CV) disease progression, and device issues compared to patients receiving standard in-office care. A secondary objective was to compare the rates of CV health care utilization between patients in the remote and in-office arms. BACKGROUND In addition to providing life-saving therapy, implantable cardioverter-defibrillators collect advanced diagnostics on the progression of the patient's heart disease. Device technology has progressed to allow wireless remote monitoring with automatic clinician alerts to replace some scheduled in-office visits. METHODS The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) study was a multicenter, prospective, randomized evaluation involving 1,997 patients from 136 clinical sites who underwent insertion of an implantable cardioverter-defibrillator (including cardiac resynchronization therapy devices) and were followed up for 15 months. Health care utilization data included all CV-related hospitalizations, emergency department visits, and clinic office visits. RESULTS The median time from clinical event to clinical decision per patient was reduced from 22 days in the in-office arm to 4.6 days in the remote arm (p < 0.001). The health care utilization data revealed a decrease in mean length of stay per CV hospitalization visit from 4.0 days in the in-office arm to 3.3 days in the remote arm (p = 0.002). CONCLUSIONS Wireless remote monitoring with automatic clinician alerts as compared with standard in-office follow-up significantly reduced the time to a clinical decision in response to clinical events and was associated with a significant reduction in mean length of CV hospital stay. (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision CONNECT; NCT00402246).
“The CONNECT data showed remote monitoring with the CareLink Network not only significantly reduced the time to clinical decision, but also may reduce the need for standard in-clinic visits, which may not always be necessary for the patient, and often place added burden on the physician's clinic. At the same time, these data lead us to believe there may be other potential benefits of remote monitoring, including a reduction in mean length of stay for cardiovascular hospitalizations, which may have an economic impact on the patient and the healthcare system.”
Crossley et al. (Mon,) studied this question.