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ICD remote patient monitoring technology underused
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Fewer than half of patients who receive an implantable cardioverter defibrillator capable of remote patient monitoring use the technology within 180 days of implant, researchers reported in a recent study.
“Despite its universal availability, [remote patient monitoring] technology is substantially underused. Lack of enrollment of eligible patients into [remote patient monitoring] systems is the major cause of underuse, with more than one-third of all patients receiving [remote patient monitoring]-capable devices not being enrolled within 180 days of device implant,” researchers wrote in Circulation.
According to the researchers, successful use of remote patient monitoring (RPM) depends on patient enrollment into an RPM system and subsequent activation of RPM by the enrolled patient.
For this study, information on the use of devices capable of RPM was obtained from the ALTITUDE program (Boston Scientific Corp.) and the NCDR ICD Registry. The researchers analyzed data on 39,158 adults with newly implanted RPM-capable devices who were categorized based on RPM system enrollment and activation.
“Currently, all ICDs are RPM-capable, and professional societies endorse the routine use of RPM in clinical practice. The extent to which RPM has been incorporated into routine clinical practice and the factors associated with failure to use RPM have not been identified,” the researchers wrote.
Of the 39,158 participants, 62% were categorized as RPM-enrolled. Of those enrolled, 76% activated their device.
Results showed variable enrollment among institutions. The researchers calculated a hospital-specific median OR of 3.43 for RPM enrollment, “signifying that physician or institutional factors are associated with RPM enrollment.” They calculated a hospital-specific median OR of 1.69 for RPM activation.
Factors associated with RPM enrollment and activation included age, race/ethnicity, insurance status and geographic location. Enrollment was less common along coastal regions of the United States compared with the central United States and among patients living close to the implant center compared with patients living farther away. In addition, RPM use was lower among patients with comorbidities, severe left ventricular dysfunction and in-hospital procedure-related complications, as well as those not admitted to the hospital for device implantation. “Thus, sicker patients who may be more likely to benefit from RPM were less likely to use this technology, which is an example of a risk-treatment paradox,” the researchers wrote.
The researchers concluded that lack of RPM system enrollment “is the major cause of underutilization, and this primarily relates to the local practice environment.”
“Whether creating institutional systems that incorporate allied health professional and ancillary support to facilitate patient enrollment as a routine part of post-implant care would increase RPM use needs to be examined,” they wrote.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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