HF patients avoid hospitalization with remote monitoring of implanted devices

A remote monitoring protocol for heart failure patients with implantable electronic devices helped more of them stay out of the hospital over a one-year period than standard in-person visits, researchers reported at EHRA 2019, a European Society of Cardiology congress in Lisbon, Portugal.

A total of 600 heart failure patients with implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds) were randomized to either remote monitoring or traditional face-to-face appointments. Patients in the remote monitoring group were significantly less likely to meet the primary composite endpoint of all-cause mortality or cardiovascular hospitalization during the next 12 months (39.5 percent vs. 48.5 percent).

Although 6 percent of people in both groups died during follow-up, the rate of cardiovascular hospitalizations was significantly lower among those receiving remote monitoring (37.1 percent vs. 45.5 percent). Those patients were supported by three levels of clinicians who staffed an office in the hospital for 10 hours each weekday—two electrophysiology nurses checked device transmissions and contacted patients if further information was needed, cardiology residents investigated suspected arrhythmias or device malfunctions and a clinical cardiologist and electrophysiologist were available to consult on difficult situations.  

“It is important to stress that remote monitoring is not effective as a plug and play gadget,” study author Mateusz Tajstra, MD, PhD, with the Silesian Centre of Heart Disease in Zabrze, Poland, said in a press release. “It will only be successful with a specified workflow to act on data retrieved from the devices, performed by a dedicated team.”

But this setup was so effective, according to the release, that it earned reimbursement from the national health system in Poland, which didn’t previously pay for remote monitoring.

“Our pragmatic approach facilitated rapid clinical reactions to data from the devices,” Tajstra said. “This prevented heart failure decompensation, where symptoms suddenly get worse and patients are often hospitalized.”