Clinical Benefits of Remote Versus Transtelephonic Monitoring of Implanted Pacemakers
Key result
Remote pacemaker interrogation detects clinically actionable events ~2 months earlier than transtelephonic monitoring.
- 66% vs 2%
Why the study?
To evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation.
Does remote pacemaker interrogation reduce the time to first diagnosis of clinically actionable events in patients with implanted pacemakers?
Key Points
- This study aims to assess the effectiveness of remote pacemaker monitoring in diagnosing clinically actionable events earlier than transtelephonic monitoring.
- Patients were randomized 2:1 to remote monitoring or control with transtelephonic monitoring and office visits.
- Remote monitoring involved interrogation at 3-month intervals; control patients transmitted data at 2-month intervals and had an office visit at 6 months.
- Time to first diagnosis of clinically actionable events was compared between groups.
- Mean time to first diagnosis was 5.7 months in the Remote arm versus 7.7 months in the Control arm.
- 66% of actionable events were detected remotely in the Remote arm compared to 2% in the Control arm (676 vs. 190 events).
- The remote pacemaker monitoring was more effective than traditional methods, suggesting it offers significant clinical benefits.
Study Design
Type
RCT
Randomization
2:1
Structured PICO
Does remote pacemaker interrogation reduce the time to first diagnosis of clinically actionable events in patients with implanted pacemakers?
P
Population
Patients with implanted pacemakers followed for 12 months.
I
Intervention
Remote pacemaker interrogation with transmissions at 3-month intervals and an office visit at 12 months
C
Comparator
Standard of care with office visits augmented by transtelephonic monitoring (transmissions at 2-month intervals, office visit at 6 months for dual-chamber devices, and office visit at 12 months for all)
O
Outcome
Time to first diagnosis of a clinically actionable event
Main Result
Absolute Event Rate: 5.7% vs 7.7%
Remote pacemaker interrogation detects clinically actionable events more quickly and frequently than traditional transtelephonic monitoring.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“With current pacemaker systems continuously recording clinical information, clinicians now have robust and objective data to diagnose clinical events; however, this information is only valuable if providers can access it in a timely manner that enables clinical intervention before the event progresses.”
“Remote programming provides a continuous stream of clinical information that is accurate, objective and up to the minute. The latter is the potential Achilles' heel, because it requires timely review and action by the health care professional, which may necessitate staffing changes. Nevertheless, this is the first step to an 'outpatient critical care unit-type environment,' which should provide better health care for patients. Just as the critical care unit nurse must act when the monitor shows a particular problem, so we must respond to the remote transmission.”
Implication
Remote monitoring may enable earlier pacemaker event detection; leaves open outcome impact in prospective trials.
Abstract
OBJECTIVES: The purpose of this study was to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation. BACKGROUND: Pacemaker patient follow-up procedures have evolved from evaluating devices with little programmability and diagnostic information solely in person to transtelephonic rhythm strip recordings that allow monitoring of basic device function. More recently developed remote monitoring technology leverages expanded device capabilities, augmenting traditional transtelephonic monitoring to evaluate patients via full device interrogation. METHODS: The time to first diagnosis of a clinically actionable event was compared in patients who were followed by remote interrogation (Remote) and those who were followed per standard of care with office visits augmented by transtelephonic monitoring (Control). Patients were randomized 2:1. Remote arm patients transmitted pacemaker information at 3-month intervals. Control arm patients with a single-chamber pacemaker transmitted at 2-month intervals. Control arm patients with dual-chamber devices transmitted at 2-month intervals with an office visit at 6 months. All patients were seen in office at 12 months. RESULTS: The mean time to first diagnosis of clinically actionable events was earlier in the Remote arm (5.7 months) than in the Control arm (7.7 months). Three (2%) of the 190 events in the Control arm and 446 (66%) of 676 events in the Remote arm were identified remotely. CONCLUSIONS: The strategic use of remote pacemaker interrogation follow-up detects actionable events that are potentially important more quickly and more frequently than transtelephonic rhythm strip recordings. The use of transtelephonic rhythm strips for pacemaker follow-up is of little value except for battery status determinations. (PREFER [Pacemaker Remote Follow-up Evaluation and Review]; NCT00294645).
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Cite This Study
Crossley et al. (2009) conducted an RCT in Implanted pacemakers. Remote pacemaker interrogation vs. Office visits augmented by transtelephonic monitoring was evaluated on Time to first diagnosis of a clinically actionable event. Remote pacemaker interrogation detected clinically actionable events earlier (mean 5.7 vs 7.7 months) and more frequently remotely (66% vs 2%) compared to transtelephonic monitoring.