A Link to Better Care: The Effect of Remote Monitoring on Long-Term Adverse Cardiac Events in a Propensity Score-Matched Cohort

• Autor(a) principal: Portugal, G
• Data de Publicação: 2017
• Outros Autores: Cunha, PS, Valente, B, Feliciano, J, Lousinha, A, Alves, S, Braz, M, Pimenta, R, Delgado, AS, Oliveira, MM, Cruz Ferreira, R
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2691
• topic: HSM CAR; Cohort Studies; Death, Sudden, Cardiac/prevention & control; Defibrillators, Implantable/adverse effects; Defibrillators, Implantable/standards; Patient Admission/statistics & numerical data; Propensity Score; Quality Improvement; Remote Sensing Technology; Retrospective Studies; Time Factors

AIMS: There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs). METHODS: We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death. RESULTS: Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS). CONCLUSION: In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death.