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PREFER: Clinically actionable events detected more quickly by remote interrogation strategy
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A strategy of pacemaker follow-up that included remote interrogation rather than transtelephonic electrocardiographic monitoring detected clinically actionable events more quickly.
“With current pacemaker systems continuously recording clinical information, clinicians now have robust and objective data to diagnose clinical events; however, this information is only valuable if providers can access it in a timely manner that enables clinical intervention before the event progresses,” Bruce L. Wilkoff, MD, FHRS, director of Cardiac Pacing and Tachyarrhythmia Devices at the Cleveland Clinic, said in a press release.
Wilkoff and colleagues conducted the prospective, randomized PREFER study to compare the rate of first diagnosis of clinically actionable events for patients who utilize remote interrogation vs. patients who are followed via routine office visits augmented by transtelephonic monitoring and to characterize the frequency of actions taken in response to the diagnoses.
Clinically actionable events were detected in 45% of participants in the remote interrogation arm and in 38% of participants in the transtelephonic rhythm strip evaluations arm, according to the researchers.
Clinically actionable events were detected earlier in the remote interrogation arm during an average follow-up of 375 days (P<.0001). New onset atrial fibrillation and sensed ventricular rate >100 beats per minute during AF/atrial tachycardia demonstrated statistical significance for earlier detection in the remote interrogation arm compared with the transtelephonic rhythm strip evaluations arm.
In the remote interrogation arm, the frequency of clinical actions in response to the events was 19% vs. the the transtelephonic rhythm strip evaluations arm (15%; P=.794). Remote transmission detected <2% of clinically actionable events, and remote interrogation detected >60%, according to the researchers. – by Christen Haigh
Remote programming provides a continuous stream of clinical information that is accurate, objective and up to the minute. The latter is the potential Achilles’ heel, because it requires timely review and action by the health care professional, which may necessitate staffing changes. Nevertheless, this is the first step to an “outpatient critical care unit-type environment,” which should provide better health care for patients. Just as the critical care unit nurse must act when the monitor shows a particular problem, so we must respond to the remote transmission.
– Douglas P. Zipes, MD
Cardiology Today Editorial Board member
For more information:
- Wilkoff BL. Pacemaker remote follow-up evaluation and review: results of the PREFER trial. SP07. Presented at: Heart Rhythm 2008: The Heart Rhythm Society’s 29th Annual Scientific Sessions; May 14-17, 2008; San Francisco