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Remote monitoring of ICD patients with HF decreased emergency, urgent care visits
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Data demonstrate that remote monitoring of patients with HF who have implantable cardioverter defibrillators reduced the rate of ED or urgent in-office visits when compared with standard patient management.
Researchers for a multicenter, randomized trial, Evolution of Management Strategies of Heart Failure Patients with Implantable Defibrillators (EVOLVO), compared the use of emergency health care in patients who used a wireless remote monitoring system with those who used standard patient management. Standard patient management consisted of scheduled visits and patient responses to audible alerts from ICDs (101 patients). Patients using the remote monitoring system (99 patients) had all been implanted with a Medtronic wireless ICD/cardiac resynchronization therapy with a defibrillator (CRT-D) using the Medtronic CareLink Network. The CareLink system used wireless communication with the ICD and allowed transmission of ICD data without patient intervention. The system can transmit data from programmable alert conditions and notify physicians via phone or email. Information can be viewed on a secure website.
The rate of ED or in-office urgent care visits for HF, arrhythmias or ICD-related events was the primary endpoint. These visits were 35% less frequent in patients with remote monitoring during a period of 16 months vs. patients with standard management. Incidence density was 0.59 events per year in the patients with remote monitoring vs. 0.93 events per year in patients with standard management (P=.005).
Rate of total health care visits for HF, arrhythmias or ICD-related events was also 21% lower in the remote monitoring study arm (4.4 vs. 5.74 events per year; P<.001).
Time from an ICD alert condition to review of the data decreased from 24.8 days among patients receiving standard care vs. 1.4 days in those using remote monitoring (P<.001).
“The main finding of the EVOLVO study is that remote management of HF patients implanted with ICD/CRT-D decreases the rate of emergency department/urgent in-office visits and in general reduces total health care use. In the presence of symptoms or device alerts, remote monitoring allows early ICD data review while reducing the need for urgent hospital examinations and increasing the appropriateness of in-office visits,” Maurizio Landolina, MD, of the Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy, and colleagues said in the study.
Disclosure: The EVOLVO study was supported by a grant from the Italian Ministry of Health and by the Regione Lombardia. Medtronic Italia provided technical support. Dr. Landolina has speakers’ bureau appointments and an advisory board relationship with Medtronic and other device companies. Dr. Valsecchi is an employee of Medtronic Inc. The other researchers report no relevant financial disclosures.
Perspective
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Douglas P. Zipes, MD
A reasonable rule of thumb is that the closer you monitor something, the better the performance. So, if individuals know their performance of a particular function is being monitored, they generally will improve that performance. It should not be a surprise that HF/ICD patients monitored remotely and having early analysis of their ICD would reduce the need for urgent evaluations. However, it had to be proven and this study does that nicely.
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