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

• Published in: Journal of the American College of Cardiology Vol. 65; no. 24; pp. 2601 - 2610
• Main Authors: Varma, Niraj, MD, PhD, Piccini, Jonathan P., MD, MHSc, Snell, Jeffery, BA, Fischer, Avi, MD, Dalal, Nirav, MS, Mittal, Suneet, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 23.06.2015; Elsevier Limited
• Subjects: Age; Aged; Aged, 80 and over; big data; cardiac electronic implantable devices; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiac Resynchronization Therapy - mortality; Cardiology; Cardiovascular; Census of Population; Cohort Studies; Confidence intervals; Defibrillators; Defibrillators, Implantable; Demographics; device; Electric Countershock - methods; Electric Countershock - mortality; Female; Follow-Up Studies; Food stamps; Humans; Internal Medicine; Male; Middle Aged; Mortality; Pacemaker, Artificial; Patient Compliance; Postal codes; Registration; Remote Sensing Technology - methods; Remote Sensing Technology - mortality; Retrospective Studies; survival; Survival Rate - trends; time in remote monitoring; Transplants & implants; United States > US; California; percentage of time in remote monitoring; pacemaker; CRT; mortality incidence rate; HR; time in remote monitoring; TRM; RM None; CIED; remote monitoring; big data; CRT-P; implantable cardioverter-defibrillator; cardiac resynchronization therapy with defibrillation capability; cardiac electronic implantable devices; cardiac resynchronization therapy; never used remote monitoring; CI; survival; CRT-D; ICD; cardiac resynchronization therapy with pacing capability; cardiac electronic implantable device; MIR; mortality; hazard ratio; MIRR; mortality incidence rate ratio; confidence interval; RM; device; PM
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.04.033

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.