Clinical Outcomes on Remote Monitoring Compliance in Patients With Implantable Cardioverter Defibrillator

ABSTRACT Background Remote monitoring (RM) is crucial in managing patients with cardiac implantable electronic devices (CIED), and has been reported to improve clinical outcomes. The study's objective is to investigate whether compliance to RM has affected patients' long‐term clinical outcomes. Methods This was a prospective single‐center cohort study of consecutive patients on RM with an implantable cardioverter‐defibrillator or cardiac resynchronization therapy defibrillator followed up from 2018 to 2024. For analysis, patients were stratified according to whether they were compliant with RM. Compliance was defined as having ≥ 2 scheduled transmissions per year. Outcomes studied were the combined endpoints of all‐cause mortality or heart failure hospitalization. Results We analyzed 207 patients, of whom 58 (28.1%) were compliant and 149 (71.9%) were non‐compliant. Baseline demographics were similar between both arms. We observed 6.9% (4/58) of compliant patients with all‐cause mortality, compared to 15.4% (23/149) of non‐compliant patients. Four percent (2/56) of compliant patients had a hospitalization for heart failure, compared to 12.2% (18/147) of non‐compliant patients. The Kaplan–Meier analysis suggested differences in the mortality and heart failure hospitalization survival function for compliant versus non‐compliant patients. Among 166 patients with available covariate data in the multivariable exponential accelerated failure time model, the time until mortality or heart failure hospitalization was longer for compliant compared to non‐compliant patients (acceleration factor 0.24, 95% CI 0.07 to 0.81; p = 0.022). Conclusion RM compliance was associated with significantly lower combined end‐points of all‐cause mortality and heart failure hospitalizations, even though individual outcomes (mortality or HF hospitalization) did not reach statistical significance.