The disconnect in remote monitoring

The evidence favors remote monitoring using implantable cardiac devices yet few take advantage of the resource.

The Heart Rhythm Society rolled out its annual conference this week in Boston with a lineup of clinical trials that may change practice in the near future. One of the late-breakers was a nationwide evaluation of remote monitoring in patients who received pacemakers, implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices in the U.S. between 2008 and 2013.

Of the more than 92,000 patients in the analysis, 58,307 did not have remote monitoring. CRT users showed the best uptake, with 51 percent using the technology. By comparison, remote monitoring was used in 29 percent of the pacemakers and 49 percent of the ICDs.

When it was allowed to be a player, remote monitoring appeared to make a difference. Adjusted analyses found an 18 percent reduction in all-cause hospitalization with remote monitoring, a finding that applied to all the types of devices. That translated into lower costs to the tune $3,700 less per patient year.

This was a retrospective, observational study with all the drawbacks that come with that kind of design. But other studies also have reached similar conclusions about the benefit of remote monitoring, including a registry-based analysis published this week. That study assessed survival benefit and also showed limited uptake.

More than half of the patients with automatic remote monitoring devices never used the remote monitoring feature. Those who did had a significantly better chance of survival compared with nonusers. That advantage increased for those who used monitoring at least 75 percent of the time.

What is the barrier? We asked that question in 2014, in a magazine article that focused on pacemakers and ICDs. Educating patients and physicians about improved outcomes and costs was key.

Presentations and publications like these help to do that, so share the word.

Candace Stuart

Editor, Cardiovascular Business