Rehospitalization rates for heart failure (HF) patients remain high and new strategies are necessary to try to reduce this burden. Research published online May 24 in Circulation suggests a solution after researchers found that telemonitoring helped to improve care and cut healthcare utilization rates.
“Heart failure (HF) patients with implantable defibrillators (ICD) or ICD for resynchronization therapy[-defibrillator] (CRT-D) often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers,” wrote Maurizio Landolina, MD, of Fondazione Policlinico S. Matteo IRCCS in Pavia, Italy, and colleagues.
During the EVOLVO (Evolution of Management Strategies of Heart Failure Patients with Implantable Defibrillators) trial, Landolina compared remote monitoring to standard patient management in 200 patients. Of the cohort, 99 patients were randomized to the remote arm and 101 were randomized to standard treatment. The study’s primary endpoint was the rate of emergency department (ED) or urgent in-office visits for HF, arrhythmia or ICD-related events.
“The ability of implantable devices to continuously monitor variables such as heart rate, the patient's daily activity, intra-thoracic impedance for the detection of fluid accumulation, the occurrence of arrhythmia and the integrity of the system may provide early warning of changes in cardiac status or of safety issues and allow timely management,” the authors wrote.
Of the 200 patients enrolled in the study between May 2008 and July 2009, all were implanted with a wireless ICD/CRT-D device utilizing the CareLink Network (Medtronic). Data were transmitted through a standard telephone connection at scheduled intervals.
The authors reported that ED visits occurred 35 percent less frequently in patients monitored remotely when compared with those who received standard care. In total, there were 192 ED/urgent office visits for HF (75 events in the remote arm and 117 in the standard arm). For arrhythmias and ICD-related episodes, the rates of ED/in-office visits were similar in both groups.
The researchers reported 1,285 healthcare utilizations during the trial. The rates of events were statistically different between the two groups, 4.4 events per year in the remote arm vs. 5.74 events per year in the standard care arm.
While overall ED visits were decreased in the remote arm, due to alerts, remote monitoring increased the rate of appropriate visits for clinically relevant ICD alerts compared to standard care, 0.57 events per year vs. 0.33 events per year. Additionally, it was reported that quality of life was better in the remote monitoring arm when compared with the standard care arm.
After the researchers measured clinical status, it was reported that 17 percent of remote monitoring patients were classified as “improved,” 49 percent as “unchanged,” and 34 percent “worsened.” These numbers for the standard arm were 20 percent, 36 percent and 44 percent, respectively.
“In comparison with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients,” the authors wrote. Remote monitoring required less healthcare utilization when compared with standard therapy. Additionally, health IT provided patients with a better quality of life.