Key result
Automatic daily remote monitoring in CRT-D patients was associated with significantly lower cardiovascular mortality (1 vs. 6 events, log-rank p=0.04) and fewer hospitalizations for decompensated heart failure.
Why the study?
The impact of remote monitoring on clinical outcomes in HF patients with CRT-D implantation remains controversial.
Does automatic daily remote monitoring reduce cardiovascular mortality and heart failure hospitalizations in heart failure patients implanted with a CRT-D?
Observational (n=88)
No
Does automatic daily remote monitoring reduce cardiovascular mortality and heart failure hospitalizations in heart failure patients implanted with a CRT-D?
Hazard Ratio: 0.882 (95% CI 0.25–3.09)
Absolute Event Rate: 2.2% vs 13.9%
p-value: p=0.845
RM with modified PARTNERS HF criteria may lower CV mortality and HF hospitalizations in CRT-D patients; leaves open need for confirmatory RCTs.
Introduction The impact of remote monitoring (RM) on clinical outcomes in heart failure (HF) patients with cardiac resynchronisation therapy-defibrillator (CRT-D) implantation is controversial. This study sought to evaluate the performance of an RM follow-up protocol using modified criteria of the PARTNERS HF trial in comparison with a conventional follow-up scheme. Material and methods We compared cardiovascular (CV) mortality (primary endpoint) and hospitalisation events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted patients with automatic RM utilising daily transmissions (RM group, n = 45) and conventional follow-up (CFU group, n = 43) in a single-centre observational study. Results After a median follow-up of 25 months, a significant advantage was seen in the RM group in terms of CV mortality (1 vs. 6 death event, p = 0.04), although RM follow-up was not an independent predictor for CV mortality (HR = 0.882; 95% CI: 0.25–3.09; p = 0.845). Patient CV mortality was independently influenced by hospitalisation events for decompensated HF (HR = 3.24; 95% CI: 8–84; p = 0.022) during follow-up. We observed significantly fewer hospitalisation events for decompensated HF (8 vs. 29 events, p = 0.046) in the RM group. Furthermore, a decreased number of total (161 vs. 263, p < 0.01) and unnecessary ambulatory in-office visits (6 vs.19, p = 0.012) were seen in the RM group as compared to the CFU group. Conclusions Follow-up of CRT-D patients using automatic RM with daily transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival. Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional follow-up.
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Ezer et al. (2021) conducted an observational in Heart failure with cardiac resynchronisation therapy-defibrillator (CRT-D) (n=88). Automatic daily remote monitoring vs. Conventional follow-up was evaluated on Cardiovascular mortality (HR 0.882, 95% CI 0.25-3.09, p=0.845). Automatic daily remote monitoring in CRT-D patients was associated with significantly lower cardiovascular mortality (1 vs. 6 events, log-rank p=0.04) and fewer hospitalizations for decompensated heart failure.
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