Continuous automatic remote patient monitoring reduced nonactionable in-person patient evaluations by 81% (0.7 vs 3.6 per patient year; p<0.001) compared with conventional follow-up.
RCT (n=1,450)
2:1
Does continuous automatic remote patient monitoring reduce nonactionable in-person patient evaluations in patients receiving implantable cardioverter-defibrillators?
Remote patient monitoring for ICD patients significantly reduces nonactionable in-person clinic visits while maintaining the discovery of clinically actionable events.
Effect estimate: 81% reduction
Absolute Event Rate: 0.7% vs 3.6%
p-value: p=<0.001
OBJECTIVES: The goal of this study was to test whether continuous automatic remote patient monitoring (RPM) linked to centralized analytics reduces nonactionable in-person patient evaluation (IPE) but maintains detection of at-risk patients and provides actionable notifications. BACKGROUND: Conventional ambulatory care requires frequent IPEs. Many encounters are nonactionable, and additional unscheduled IPEs occur. METHODS: Patients receiving implantable cardioverter-defibrillators for Class I/IIa indications were randomized (2:1) to RPM or conventional follow-up, and they were followed up for 15 months. IPEs were conducted every 3 months in the conventional care group but at 3 and 15 months with RPM. Groups were compared for patient retention, nonactionable IPEs, and discovery of at-risk patients during 1 year of exclusive RPM. Frequency and value of RPM alerts were assessed. RESULTS: Patients enrolled (mean age 63.5 ± 12.8 years; male 71.9%; left ventricular ejection fraction 29.0 ± 10.7%; primary prevention 72.3%; n = 1450) were similar between groups (977 RPM vs. 473 conventional care). Mean follow-up durations were 407 ± 103 days for the RPM group versus 399 ± 111 days for the conventional care group (p = 0.165). Patient attrition to follow-up was 42% greater with conventional care (20.1% 87 of 431) versus RPM (14.2% 129 of 908; p = 0.007). Nonactionable IPEs were reduced 81% by RPM (0.7 per patient year) compared with conventional care (3.6 per patient year; p 50% actionability, indicating low volume but high clinical value. Unscheduled IPE was the basis for discovery of 100% of intercurrent problems in RPM and also 75% in conventional care, indicating limited value of appointment-based follow-up for problem discovery. The number of IPEs needed to discover an actionable event was 8.2 in Conventional, 4.9 in RPM, and 2.1 when alert driven (p < 0.001). CONCLUSIONS: RPM transformed ambulatory care to IPE directed to those patients with clinically actionable events when required. Filtering patient information by digitally driven remote monitoring expends fewer clinic resources while providing a greater yield of actionable interventions. (Lumos-T Safely Reduces Routine Office Device Follow-up TRUST; NCT00336284).
Varma et al. (Wed,) conducted a rct in Implantable cardioverter-defibrillator recipients (n=1,450). Continuous automatic remote patient monitoring (RPM) vs. Conventional follow-up was evaluated on Nonactionable in-person patient evaluations (IPEs) (81% reduction, p=<0.001). Continuous automatic remote patient monitoring reduced nonactionable in-person patient evaluations by 81% (0.7 vs 3.6 per patient year; p<0.001) compared with conventional follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: