Comprehensive vs. standard remote monitoring of cardiac resynchronization devices in heart failure patients: results of the ECOST-CRT study

• Published in: Europace (London, England) Vol. 26; no. 10
• Main Authors: Klein, Cédric, Kouakam, Claude, Lazarus, Arnaud, de Groote, Pascal, Bauters, Christophe, Marijon, Eloi, Mouquet, Frédéric, Degand, Bruno, Guyomar, Yves, Mansourati, Jacques, Leclercq, Christophe, Guédon-Moreau, Laurence
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 03.10.2024
• Subjects: Aged; Cardiac Resynchronization Therapy - methods; Cardiac Resynchronization Therapy Devices; Clinical Research; COVID-19; Female; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Quality of Life; Remote Sensing Technology; Surveys and Questionnaires; Telemedicine; Treatment Outcome; Heart failure; Cardiac resynchronization therapy; Remote monitoring
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euae233

Integrating remote monitoring (RM) into existing healthcare practice for heart failure (HF) patients to improve clinical outcome remains challenging. The ECOST-CRT study compared the clinical outcome of a comprehensive RM scheme including a patient questionnaire capturing signs and symptoms of HF and notifications for HF specific parameters to traditional RM in patients with cardiac resynchronization therapy (CRT) devices. Patients were randomized 1:1 to standard daily RM (notification for technical parameters and ventricular arrhythmias; control group) or comprehensive RM (adding a monthly symptom questionnaire and notifications for biventricular pacing, premature ventricular contraction, atrial arrhythmias; active group). The primary endpoint was all-cause mortality or hospitalization for worsening HF (WHF). Six hundred fifty-two patients (70.4 ± 10.3 years, 73% men, left ventricular ejection fraction 29.1 ± 7.6%, 68% CRT-Defibrillators, 32% CRT-Pacemakers) were enrolled. The COVID-19 pandemic caused an early termination of the study, so the mean follow-up duration was 18 ± 8 months. No statistically significant difference in the primary endpoint was found between the groups [59 (18.3%) control vs. 77 (23.3%) active group; log-rank test P = 0.13]. Among the secondary endpoints, the MLHF questionnaire showed a larger share of patients with improvement of quality of life compared to baseline in the active group (78%) vs. control (61%; P = 0.03). The study does not support the notion that comprehensive RM, when compared to standard RM, in HF patients with CRT improves the clinical outcome of all-cause mortality or WHF hospitalizations. However, this study was underpowered due to an early termination and further trials are required. Clinical Trials.gov Identifier: NCT03012490.