Original Investigation
The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients

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Abstract

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 = 115,076; 43%), ICDs (n = 85,014; 32%), CRT-D (n = 61,475; 23%), and CRT-P (n = 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.

Key Words

big data
cardiac electronic implantable devices
cardiac resynchronization therapy
device
mortality
survival
time in remote monitoring

Abbreviations and Acronyms

CI
confidence interval
CIED
cardiac electronic implantable device
CRT
cardiac resynchronization therapy
CRT-D
cardiac resynchronization therapy with defibrillation capability
CRT-P
cardiac resynchronization therapy with pacing capability
HR
hazard ratio
ICD
implantable cardioverter-defibrillator
MIR
mortality incidence rate
MIRR
mortality incidence rate ratio
PM
pacemaker
RM
remote monitoring
RM None
never used remote monitoring
TRM
time in remote monitoring
%TRM
percentage of time in remote monitoring

Cited by (0)

Dr. Varma has received consulting fees/honoraria from St. Jude Medical, Boston Scientific, Sorin, Biotronik, and Medtronic. Dr. Piccini has received research grants from ARCA Biopharma, Boston Scientific, Gilead, Janssen, ResMed, and St. Jude Medical; and is a consultant for Bayer, ChanRx, JNJ, Medtronic, and Spectranetics. Drs. Fischer, Snell, and Dalal are employees of St. Jude Medical. Dr. Mittal is a consultant for Boston Scientific, Medtronic, Sorin, and St. Jude Medical.

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