Remote monitoring associated with greater survival for patients with pacemakers

Issue: June 2014

SAN FRANCISCO — Utilization of remote monitoring may improve survival outcomes for patients with pacemakers, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.

Perspective from Paul A. Friedman, MD, FHRS

Remote monitoring for patients with implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators has been shown to improve survival, but a study presented here is the first to show that the effect is the same for patients with pacemakers.

“Despite the availability of [remote monitoring], the majority of patients who undergo device implantation in the United States are not enrolled in a remote monitoring program or, if enrolled in a remote monitoring program, do not reliably engage with remote monitoring,” Suneet Mittal, MD, FHRS, from The Valley Health System of New York and New Jersey, New York City, said at a press conference. “This is concerning.”

Suneet Mittal

Mittal and colleagues evaluated 262,564 patients (mean age 71 years; 65% men) implanted with a St. Jude Medical pacemaker, cardiac resynchronization therapy pacemaker, ICD or CRT-D who were not enrolled in any clinical trials.

Using Merlin.net, St. Jude’s remote monitoring system, the researchers determined weekly remote monitoring service utilization. They prospectively compared all-cause survival for patients with each device type, stratifying by remote monitoring service utilization: high (≥75%), low (≥0% to <75%) or none (0%). The cutoff of 75% was chosen because it is the median for those who had utilization greater than none, and was used in a previous study, according to Mittal.

Remote monitoring has survival benefit

Patients with remote monitoring had significantly higher survival rates than those without, regardless of device type (HR=1.81; 95% CI, 1.77-1.86). This finding was consistent across device type.

For patients with pacemakers (n=112,692), those with high remote monitoring service utilization had better survival rates than those with no remote monitoring service utilization (HR=2.3; 95% CI, 2.1-2.4). Furthermore, patients with low remote monitoring service utilization had better survival rates than those with no utilization (HR=1.4; 95% CI, 1.3-1.5) and patients with high remote monitoring service utilization had better survival rates than those with low utilization (HR=1.6; 95% CI, 1.5-1.7).

For patients with cardiac resynchronization therapy pacemakers (n=7,704), those with those with high remote monitoring service utilization had better survival rates than those with no utilization (HR=2.1; 95% CI, 1.8-2.5) and those with low remote monitoring service utilization had better survival rates than those with no utilization (HR=1.7; 95% CI, 1.5-2.1). The researchers found no difference between patients with high or low utilization (HR=1.2; 95% CI, 0.9-1.5).

Population density a factor

Perhaps surprisingly, patients living in high-density areas were less likely to be enrolled in a remote monitoring program and to use remote monitoring, compared with patients living in low-density areas, Mittal said. This could be because doctors and patients perceive remote monitoring more as a convenience than as something with a clinical benefit, he said.

“Our findings suggest that [remote monitoring] is a readily available technology and all patients should be enrolled in remote monitoring and encouraged to engage [in it] at a high level, because the [associated] mortality reductions are of a very significant and sizable proportion,” Mittal said. – by Erik Swain

For more information:

Mittal S. Abstract LB01-05. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 7-10, 2014; San Francisco.

Disclosure: The study was funded by St. Jude Medical. Mittal reports financial ties with Biosense Webster, Biotronik, Boehringer Ingelheim, Boston Scientific, Greatbach Technologies, Medtronic, St. Jude Medical, Topera Medical and TyRx.

Perspective

Paul A. Friedman, MD, FHRS

This study reinforces the importance of enrolling patients in remote monitoring. It highlights the need to identify any barriers to monitoring and to progressively address those. When you consider that every patient in this study has undergone an invasive surgical procedure and an implantation of an expensive device, and that we have data showing that there is benefit if you simply monitor that device with something that takes no effort on the patient’s part, we need to make it happen.

Paul A. Friedman, MD, FHRS

Consultant, Cardiovascular Devices

Professor of Medicine, College of Medicine, Mayo Clinic

Disclosures: Friedman reports receiving research grants from Biotronik and Medtronic, consulting for Medtronic, receiving royalty income from Bard Electrophysiology and holding intellectual property rights on Aegis Group, Bard Electrophysiology and Sorin Group products.