Studies Suggest Remote Monitoring Improves Patient Outcomes

May 14, 2014 in News

Remote monitoring may improve clinical outcomes in patients with implanted cardiac devices, according to two studies presented at a recent Heart Rhythm Society meeting, MedPage Today reports.

Study on St. Jude Devices

The first study, presented by Suneet Mittal of the Valley Health System of New York and New Jersey, examined the health outcomes of 262,564 patients who were implanted with commercially available St. Jude Medical devices over a four-year period. The devices included:

  • Cardiac resynchronization therapy (CRT) pacemakers;
  • CRT defibrillators;
  • Implantable cardioverter-defibrillators (ICDs); and
  • Pacemakers.

All of the devices were able to remotely monitor patients’ statuses via the Merlin.net Patient Care Network.

For the study, adherence to remote monitoring was defined by the percentage of follow-up weeks with a status transmission from the device. The study found:

  • 25% of patients had high adherence, with 75% or more of weeks with a transmission;
  • 21% of patients had low adherence, with more than 0% but less than 75% of weeks with a transmission; and
  • 54% of patients did not use remote monitoring at all.

Overall, the study showed that rates of survival increased as adherence increased.

In addition, the study found that patients were less likely to use remote monitoring if they lived in more highly populated areas, such as:

  • California;
  • Chicago;
  • Florida; and
  • The Northeast.

Meanwhile, patients living in less populated areas, such as the Midwest and the Pacific Northwest, were more likely to use remote monitors.

The Mayo Clinic’s Paul Friedman said the study’s results would make him more likely to suggest remote monitoring, which is currently only used by a small number of patients with cardiac devices throughout the country.

Study on ICDs and CRT Defibrillators

The second study, presented by Yale’s Joseph Akar, examined patients implanted with Boston Scientific ICDs both with and without CRT from 2006 to 2010.

The study was conducted by a collaboration of researchers at the American College of Cardiology’s National Cardiovascular Data Registry, Boston Scientific and Yale University.

For the study, researchers analyzed data on more than 50,000 patients from the:

  • NCDR ICD registry;
  • Boston Scientific ALTITUDE database;
  • Social Security Death Master File; and
  • Medicare fee-for-service claims.

The study found that 20.9% of patients died and 69.3% of patients were rehospitalized during a three-year follow-up period.

However, researchers found that remote monitoring was associated with lower risks of both death and hospital readmission after adjusting for:

  • Demographics;
  • Device and procedure characteristics;
  • Medical status and comorbidities; and
  • Physician and facility characteristics.

While the findings were consistent across different subgroups, the study suggested that remote monitoring did not have as substantial an effect on hospital readmission among:

  • Non-white patients; and
  • Patients whose devices served as secondary prevention.

Akar noted that the research had some limitations but said that “given the fact that remote monitoring is significantly underutilized despite its very widespread availability, our findings provide evidence supporting broader use of this technology” (Neale, MedPage Today, 5/13).

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