The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and De fi brillator Patients

Fro Me xD rec rec con Dr Lis Ma BACKGROUND Remote monitoring (RM) technology embedded within cardiac rhythm devices permits continuous monitoring, which may result in improved patient outcomes. OBJECTIVES This study used “big data” to assess whether RM is associated with improved survival and whether this is influenced by the type of cardiac device and/or its degree of use. METHODS We studied 269,471 consecutive U.S. patients implanted between 2008 and 2011 with pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy (CRT) with pacing capability (CRT-P)/defibrillation capability (CRT-D) with wireless RM. We analyzed weekly use and all-cause survival for each device type by the percentage of time in RM (%TRM) stratified by age. Socioeconomic influences on %TRM were assessed using 8 census variables from 2012. RESULTS The group had implanted PMs (n 1⁄4 115,076; 43%), ICDs (n 1⁄4 85,014; 32%), CRT-D (n 1⁄4 61,475; 23%), and CRT-P (n 1⁄4 7,906; 3%). When considered together, 127,706 patients (47%) used RM, of whom 67,920 (53%) had $75%TRM (high %TRM) and 59,786 (47%) <75%TRM (low %TRM); 141,765 (53%) never used RM (RM None). RM use was not affected by age or sex, but demonstrated wide geographic and socioeconomic variability. Survival was better in high %TRM versus RM None (hazard ratio [HR]: 2.10; p < 0.001), in high %TRM versus low %TRM (HR: 1.32; p < 0.001), and also in low %TRM versus RM None (HR: 1.58; p < 0.001). The same relationship was observed when assessed by individual device type. CONCLUSIONS RM is associated with improved survival, irrespective of device type (including PMs), but demonstrates a graded relationship with the level of adherence. The results support the increased application of RM to improve patient outcomes. (J Am Coll Cardiol 2015;65:2601–10) © 2015 by the American College of Cardiology Foundation. R emote monitoring (RM) of patients with cardiac electronic implantable devices (CIEDs) continues to evolve (1). Although originally devised to facilitate patient access and/or clinic efficiency by replacing the need for in-person follow-up evaluations, RM is now being explored as m the *Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; dical Center, Duke University, Durham, North Carolina; zScientific Divisio epartment of Electrophysiology, Valley Health System, New York, New eived consulting fees/honoraria from St. Jude Medical, Boston Scientifi eived research grants from ARCA Biopharma, Boston Scientific, Gilead sultant for Bayer, ChanRx, JNJ, Medtronic, and Spectranetics. Drs. Fische . Mittal is a consultant for Boston Scientific, Medtronic, Sorin, and St. Jud ten to this manuscript’s audio summary by JACC Editor-in-Chief Dr. Vale nuscript received January 14, 2015; revised manuscript received March 2 a method for improving patient outcomes (2–8). Newer technologies embedded in CIEDs permit daily monitoring with automatic early notification of changes in patient’s clinical condition and device (mal)function (9). These notifications enable prompt clinical intervention, irrespective of follow-up yDuke Clinical Research Institute, Duke University n, St. Jude Medical, Inc., Sylmar, California; and the York and Ridgewood, New Jersey. Dr. Varma has c, Sorin, Biotronik, and Medtronic. Dr. Piccini has , Janssen, ResMed, and St. Jude Medical; and is a r, Snell, and Dalal are employees of St. Jude Medical. e Medical. ntin Fuster. 3, 2015, accepted April 7, 2015. ABBR EV I A T I ON S