Key result
Remote monitoring of implantable devices enables earlier detection of actionable events but has not consistently improved patient outcomes in clinical trials except in specific heart failure cohorts.
Why the study?
Earlier detection of clinically actionable events with remote monitoring has largely failed to translate into improved patient outcomes in heart failure clinical trials, prompting an evaluation of potential reasons for these trial discrepancies.
Does remote monitoring improve patient outcomes in heart failure patients with ICDs or CRT-Ds compared to traditional in-patient evaluation?
Does remote monitoring improve patient outcomes in heart failure patients with ICDs or CRT-Ds compared to traditional in-patient evaluation?
To translate the earlier event detection of remote monitoring into improved clinical outcomes for heart failure patients with devices, optimized patient selection, frequent data transmission, and structured clinical response algorithms are needed.
Does not support broad adoption for outcome gains; leaves open optimized protocols in select heart failure device cohorts.
Remote monitoring (RM) has become a new standard of care in the follow-up of patients with implantable pacemakers and defibrillators. While it has been consistently shown that RM enables earlier detection of clinically actionable events compared with traditional in-patient evaluation, this advantage did not translate into improved patient outcomes in clinical trials of RM except one study using daily multiparameter telemonitoring in heart failure (HF) patients. Therefore, this review, focusing on RM studies of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators in patients with HF, discusses possible explanations for the differences in trial outcomes. Patient selection may play an important role as more severe HF and concomitant atrial fibrillation have been associated with improved outcomes by RM. Furthermore, the technical set-up of RM may have an important impact as a higher level of connectivity with more frequent data transmission can be linked to better outcomes. Finally, there is growing evidence as to the need of effective algorithms ensuring a fast and well-structured clinical response to the events detected by RM. These factors re-emphasize the potential of remote management of device patients with HF and call for continued clinical research and technical development in the field.
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Braunschweig et al. (2019) conducted a review in Heart failure. Remote monitoring vs. Traditional in-patient evaluation was evaluated on Patient outcomes. Remote monitoring of implantable devices enables earlier detection of actionable events but has not consistently improved patient outcomes in clinical trials except in specific heart failure cohorts.
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