HRS Doesn’t Miss a Beat with Cutting-edge Trials

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 - Jonathan P. Piccini, MD
"In routine clinical practice in this nationwide sample, we saw that remote monitoring was associated with improved clinical outcomes,” says Jonathan P. Piccini, MD, of Duke University Medical Center in Durham, N.C.
Source: HRS

The Heart Rhythm Society focused on the latest developments in electrophysiology and the management of patients with rhythm disorders and heart failure at its 2015 meeting on May 13-16 in Boston. The event included 12 late-breaking clinical trials.

Remote monitoring leads to cost savings, fewer hospitalizations

Patients who had remote monitoring in their implantable electronic cardiac devices had lower all-cause hospitalization costs and recurrent hospitalizations compared with patients without remote monitoring capabilities, according to a large, retrospective, cohort study.

After adjusting for patients’ age, sex and geographic location, there was an 18 percent reduction in all-cause hospitalization associated with the use of remote monitoring. The benefit was consistent across all devices from all manufacturers, including patients with pacemakers who did not have high-voltage devices.

Researchers also found that remote monitoring was associated with a $3,700 reduction in costs per patient year. They estimated that for every 100,000 patient-years, the use of remote monitoring was associated with 9,810 fewer hospitalizations, 119,000 fewer days in the hospital and more than $370,000 savings in hospital costs.

“We learned that in routine clinical practice in this nationwide sample, we saw that remote monitoring was associated with improved clinical outcomes,” says presenter Jonathan P. Piccini, MD, of Duke University Medical Center in Durham, N.C. “And those improved clinical outcomes were associated with significant decreases in healthcare expenditures for all-cause hospitalization.”

The researchers analyzed remote monitoring use in adult patients who received pacemakers, implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices in the U.S. between April 1, 2008 and March 31, 2013. Of the 92,566 patients who met the inclusion criteria, 34,259 had remote monitoring and 58,307 did not have remote monitoring; 59 percent of patients received pacemakers, 30 percent ICDs and 11 percent CRT devices. Remote monitoring was used in 29 percent of the pacemakers, 49 percent of the ICDs and 51 percent of the CRT devices.

Among patients who were hospitalized, the mean length of stay was 5.3 days in the remote monitoring group and 8.1 days in the group that did not have remote monitoring. The difference was statistically significant.

The magnitude of the lower risk of hospitalization was greater in ICD recipients and patients with CRT devices compared with those who received pacemakers.

There was a 43 percent reduction in all-cause hospitalization costs in ICD recipients and a 45 percent cost reduction in CRT device recipients, which Piccini says was associated with an $11,000 reduction in healthcare expenditures per year.

In patients with a prior diagnosis of heart failure, use of remote monitoring was associated with a 31 percent reduction in costs and a statistically significant decrease in length of hospital stay of 2.5 days.

No adverse outcomes in patients with ICD system undergoing MRIs

Patients with the Iforia ProMRI implantable cardiac device (ICD) system had no adverse outcomes related to the device and no significant changes to pacing or sensing parameters after undergoing a thoracic spine or cardiac MRI, according to a multicenter, nonrandomized trial.

All episodes of life-threatening ventricular arrhythmias were appropriately detected and treated. The MRI had no impact on the ICD’s main function of detecting and treating arrhythmias.

Researcher Khaled Awad, MD, presented results of the study during a late-breaking clinical trials session at Heart Rhythm 2015. Biotronik, the device’s manufacturer, funded the study.

No ICD systems currently have an FDA labeling indicating they are safe for use in MRIs, according to  Awad, of the University of Alabama at Birmingham. Patients with ICDs typically do not undergo an MRI because of potential adverse outcomes, including interactions between the ICD system and the electromagnetic fields generated by the MRI machine. However, some pacemakers are designed to work with MRIs, although the successful interaction between ICDs and MRIs is unknown. Biotronik, which funded the study, initiated the trials to investigate the safety and efficacy of ICD platforms in MRIs.

Of the 170 patients who were provisionally enrolled at 39 centers in the U.S., 154 met the eligibility criteria. All but six patients underwent a cardiac or thoracic MRI with a standard