Telemonitoring in Patients with Congestive Heart Failure and Indication for ICD-Cardiac Resynchronization Therapy : TRIAGE-CRT 1

Aims: Results from previous studies suggest that remote monitoring may benefit patients with heart failure (HF). The TRIAGE-CRT study prospectively evaluates the combined use of cardiac resynchronization therapy defibrillator (CRT-D)-based home monitoring (HM) in conjunction with weight and blood pressure (BP) electronic telemonitoring (ETM) in patients with HF. Methods and Results: 66 patients were enrolled and followed up at 3 and 6 months post implant with interim follow-up as necessary. Weight and BP were evaluated by weekly telemonitoring starting within 7–14 days post enrollment. Enrolled patients had depressed left ventricle (LV) function (age 65 ¡ 11 years, left ventricular ejection fraction (LVEF) 24 ¡ 7%, systolic resting BP 120 ¡ 18 mm Hg, diastolic resting BP 71 ¡ 15 mm Hg, etiology of HF: ischemic 58%, non-ischemic 42%). The average number of days with successful telemonitoring Address correspondence to: Jagmeet Singh, MD, Cardiac Arrhythmia Service, GRB 109 Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02412, USA. E-mail: jsingh@partners.org Manuscript received March 31, 2011, final version accepted May 19, 2011. Dr. Chatterjee reports no disclosures; Dr. Gallagher reports that he receives research support from Biotronik and serves on a local institutional review board; Dr. Ip reports that he receives research grants from St. Jude Medical, Biotronik, Medtronic and Atricure, serving on advisory boards for St. Jude Medical, Biotronik and Atricure, and receiving lecture fees for Biotronik, Medtronic, Astra Zeneca and Atricure; Dr. Poku reports serving as a speaker for Sanofi Aventis and Boehringer Ingelheim; Dr. Malik reports serving as a consultant for Sorin and St. Jude Medical; Dr. Akar reports receiving research support from Boston Scientific Corp., serving as a consultant to Biosense-Webster and Biotronik, and as a speaker for St. Jude Medical; K. Mitchell is a paid employee of Biotronik, however, no bonuses are tied to clinical study outcomes; Dr. Singh reports receiving research grants from St. Jude Medical, Medtronic Inc., Boston Scientific Corp. and Biotronik, serving on advisory boards or as a consultant for Boston Scientific Corp., CardioInsight. Thoratec Inc., St. Jude Medical and Medtronic and receiving lecture fees from Medtronic Inc., Biotronik, Guidant Corp., St. Jude Medical and Sorin Group. In addition to the individual disclosures noted above, the institutions of several authors (Drs. Chatterjee, Gallagher, Akar, Poku, Ip, Malik, and Singh) participated as an enrolling site in TRIAGE-CRT and received research support from Biotronik for conduct of the trial. The Journal of Innovations in Cardiac Rhythm Management, 2 (2011), 347–352 347 The Journal of Innovations in Cardiac Rhythm Management, June 2011 DOI: 10.19102/icrm.2011. 020 0 8 6 6 transmission was significantly higher for HM (135.4 ¡ 6.6) when compared to weight (117.7 ¡ 6.2) and BP (111.8 ¡ 6.2) ETM (p for comparison 5 0.010 and 0.011, respectively). Transmission success, defined as the ratio of actual per expected daily transmission, was also higher for HM (0.806 ¡ 0.030) versus weight (0.683 ¡ 0.035) and BP (0.685 ¡ 0.037) (p for comparison 5 0.008 and 0.011, respectively). Wireless transfer of CRT device event notifications resulted in more frequent actionable visits compared to BP or weight transmissions. Conclusions: TRIAGE-CRT demonstrates that transfer of CRT-D-based diagnostics was more frequent than weight and BP transmissions. Continuous HM in the CRT patient enables timely intervention, facilitating both remote and office-based interventions.