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July 13, 2009Journal of Cardiovascular ElectrophysiologyOpen Access

Home Monitoring in Patients with Implantable Cardiac Devices: Is There a Potential Reduction of Stroke Risk? Results from a Computer Model Tested Through Monte Carlo Simulations

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Key result

Simulated daily home monitoring reduced stroke incidence in case of AF to 2.3% compared to 2.9% with 12-month standard follow-up (OR 0.82; 95% CI 0.79-0.85).

Why the study?

Does home monitoring reduce stroke risk compared to standard in-person follow-up in patients with pacemakers and ICDs?

Population

4,000 virtual subjects simulated based on a real sample of 136 pacemaker and ICD patients with or without…

Comparison

Home monitoring remote control with automatic… vs Standard in-person follow-up at 3, 6, 9, or 12…

Design

Other

Follow-up

2 years (simulated)

Authors

RRRenato Pietro RicciLMLoredana MorichelliAGAlessio Gargaro

Discussion

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Overview

May modestly lower stroke risk with daily home monitoring in device patients; hypothesis-generating and requires randomized confirmation.

Structured PICO

Does home monitoring reduce stroke risk compared to standard in-person follow-up in patients with pacemakers and ICDs?

P
Population
4,000 virtual subjects simulated based on 136 pacemaker and ICD patients not taking anticoagulation at implant, followed for 2 years.
I
Intervention
Home monitoring (HM) remote control with automatic alerts for atrial fibrillation
C
Comparator
Standard in-person follow-up (SF) at 3, 6, 9, or 12 months
O
Outcome
Stroke incidence in case of atrial fibrillationhard clinical

Main Result

Odds Ratio: 0.82 (95% CI 0.79–0.85)

Absolute Event Rate: 2.3% vs 2.9%

Monte Carlo simulations suggest that daily home monitoring of pacemaker and ICD patients may reduce stroke risk by 9% to 18% compared to standard in-person follow-up every 6 to 12 months.

Cite This Study

Ricci et al. (2009) studied Patients with pacemakers and implantable defibrillators (ICD) (n=4,000). Home monitoring (HM) remote control with automatic alerts for AF vs. Standard in-person follow-up (SF) at 3, 6, 9, or 12 months was evaluated on Stroke incidence in case of AF (OR 0.82, 95% CI 0.79-0.85). Simulated daily home monitoring reduced stroke incidence in case of AF to 2.3% compared to 2.9% with 12-month standard follow-up (OR 0.82; 95% CI 0.79-0.85).

synapsesocial.com/papers/6aa0352adf7ec5b4af9affb4https://doi.org/10.1111/j.1540-8167.2009.01543.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Remote, Wireless, Ambulatory Monitoring of Implantable Pacemakers, Cardioverter Defibrillators, and Cardiac Resynchronization Therapy Systems: Analysis of a Worldwide Database2007 · 229 citations
  2. 2Potential Cost Savings by Telemedicine‐Assisted Long‐Term Care of Implantable Cardioverter Defibrillator Recipients2005 · 126 citations
  3. 3Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic Events2008 · 381 citations
  4. 4Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia Pacemakers2005 · 403 citations
  5. 5Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke2007 · 332 citations