PREDICt-RM: Remote monitoring reduced mortality in patients with ICDs, CRT-Ds

SAN FRANCISCO — In a new study, use of remote monitoring in patients with Boston Scientific implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators was associated with improved survival compared with no remote monitoring.

Perspective from Dan M. Roden, MD

Researchers combined data from the Boston Scientific Altitude registry and the American College of Cardiology National Cardiovascular Data registry to examine the association of remote monitoring use with all-cause mortality and all-cause hospitalization in the PREDICt-RM study. Joseph G. Akar, MD, PhD, from Yale University School of Medicine, presented the findings at the Heart Rhythm Society Annual Scientific Sessions.

The study cohort consisted of 37,742 patients (mean age, 67 years; 72% men) undergoing a first-time ICD or CRT-D implant between January 2006 and March 2010. The researchers used the Social Security Death Master File to compare mortality rates between those who used Boston Scientific’s Latitude wireless remote monitoring system (n=22,023) and those who did not. In a subset of patients enrolled in Medicare fee-for-service (n=15,254), they also compared all-cause rehospitalization rates between those remotely monitored and those not.

After a median follow-up of 832 days, the overall cohort had a 3-year mortality rate of 20.9%. Patients who used remote monitoring had a lower risk for mortality compared with those who did not (HR=0.67; 95% CI, 0.64-0.7), according to multivariable analysis. The results were consistent regardless of age, sex, race, ICD type, indication and ischemic vs. nonischemic cardiomyopathy.

In the subset of patients analyzed for rehospitalization, the 3-year rehospitalization rate was 69.3% after a median follow-up of 922 days. Patients who used remote monitoring (n=9,150) had a lower risk for rehospitalization than those who did not (HR=0.81; 95% CI, 0.79-0.83), according to results presented.

“The PREDICt-RM results demonstrate improved outcomes for those ICD and CRT-D patients using the Latitude wireless remote patient management system,” Akar said in a press release issued by Boston Scientific. “Despite the widespread availability of this technology, we know that it is underutilized. Our hope is that this study may inform clinical practice guidelines and promote the routine use of this technology in daily practice.” – by Erik Swain

For more information:

Akar JG. Abstract LB03-03. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 7-10, 2014; San Francisco.

Disclosure: The study was funded by Boston Scientific and the American College of Cardiology. Akar reports financial ties with Biosense Webster and Biotronik.

Perspective

Dan M. Roden, MD

I think we all find very appealing the idea that monitoring people remotely will contribute to improved outcomes. But payers are not willing to pony up for that sort of thing unless there’s a benefit that they can see. So I like the idea of showing that 21^st century approaches actually contribute to improved outcomes: While the advantages in the technology may be self-evident, what we need are more data around actual outcomes, and intensive monitoring of device function remotely seems like one good way to get there.

Dan M. Roden, MD

Cardiology Today Editorial Board member

Disclosures: Roden reports no relevant financial disclosures.