Although current guidelines recommend remote patient monitoring (RPM) with implantable cardioverter-defibrillators (ICDs), a study published online Sept. 16 in Circulation found that RPM is vastly underutilized. Fewer than half of patients whose devices allow for RPM use it within six months of their implants.
“Lack of enrollment of eligible patients into RPM systems is the major cause of underutilization, with more than a third of all patients receiving RPM-capable devices not being enrolled within 180 days of device implant,” wrote the authors, led by Joseph G. Akar, MD, PhD, of Yale University School of Medicine. “Furthermore, use of RPM is not uniform among different institutions.”
The Patient RElated Determinants of ICD Remote Monitoring (PREDICt RM) study involved more than 24,000 patients with new ICDs. Boston Scientific Corp., which paid for some of the research, provided information on the use of the devices, which were also linked to the National Cardiovascular Data Registry ICD registry.
Patients were divided into RPM-enrolled and RPM-not enrolled groups, and the enrolled patients were subdivided into RPM-active and RPM-inactive groups, depending on whether there was RPM data available from their devices.
Of the 24,113 patients participating in PREDICt RM, 62 percent were enrolled in RPM within six months of getting their device. Of the RPM-enrolled patients, 76 percent activated their device within six months and 24 percent did not, meaning that about 47 percent of all participants activated RPM.
“[T]he single-most important determinant of RPM enrollment was related to the providing institution in which the ICD was implanted,” the authors found. Referring specifically to hospitals, the median odds ratio was 3.43, meaning that a patient selected at random who received an ICD at one hospital would have 3.43 times higher odds of being RPM-enrolled than a similar patient at a different hospital in the sample. The hospital-specific median odds ratio for RPM activation was 1.69.
Hospitals varied in their enrollment of patients as well. Only 10.5 percent of hospitals enrolled all patients, and 13.3 percent did not enroll anyone.
The authors found that physician characteristics did not significantly affect RPM activation. In addition, patient characteristics such as age, race, health insurance and reason for admission affected RPM activation. For example, older patients were more likely to activate RPM.
“Since many of the determinants of RPM use are modifiable, healthcare providers, institutions and payers may consider strategies that promote RPM utilization,” they wrote.