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Remote monitoring of cardiac devices reduces hospitalizations, costs
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BOSTON — Remote monitoring, regardless of device type, was associated with reduced hospitalizations and costs, according to results of an analysis presented at the Heart Rhythm Society Annual Scientific Sessions.
Researchers investigated whether remote monitoring is associated with reduced all-cause clinical events and health care costs. They evaluated 92,566 patients aged 21 years or older (mean age, 72 years; 63% men) implanted with a pacemaker, implantable cardioverter defibrillator or cardiac resynchronization therapy device from April 2008 to March 2013 who were included in the MarketScan Commercial and Medicare Supplemental claims databases.
Patients were stratified by whether they had remote monitoring and clinic follow-up, or clinic follow-up only; approximately one-third had remote monitoring. Follow-up regimens, hospitalization events and costs were determined from claims after implant.
Jonathan P. Piccini
The mean time interval between follow-up was more frequent among patients with remote monitoring than those without remote monitoring, Jonathan P. Piccini, MD, MHSc, FACC, FAHA, FHRS, and colleagues reported.
Compared with no remote monitoring, remote monitoring was associated with lower all-cause hospitalization costs per patient-year, shorter mean length of stay (5.3 days vs. 8.1 days; P < .001) and fewer hospitalization events per patient-year (adjusted HR for all = 0.82; 95% CI, 0.8-0.84), Piccini, associate professor of medicine at Duke University Medical Center and Duke Clinical Research Institute, said at a press conference.
While the lower risk for hospitalization was observed across all devices, patients with ICDs (HR = 0.74; 95% CI, 0.71-0.77) and CRT-defibrillators (HR = 0.72; 95% CI, 0.67-0.77) had the greatest magnitude of benefit associated with remote monitoring, Piccini said.
Hospital cost differences were 30% lower in the remote monitoring group, and the biggest differences were observed in patients with ICDs (43%) and CRT-Ds (45%), Piccini said.
In patients with a prior diagnosis of HF, the risk for HF hospitalization was lower in those with remote monitoring (HR = 0.76; 95% CI, 0.71-0.81). In addition, Piccini said, 30-day rehospitalization for HF was lower in those with remote monitoring (8.8% vs. 11.3%) and there was an absolute difference of almost 7% in those with CRT-Ds (11.2% vs. 17.8%).
In patients with known atrial fibrillation, remote monitoring was associated with a lower risk for hospitalization for stroke (1.1 per 100 patient-years vs. 1.63 per 100 patient-years; HR = 0.78; 95% CI, 0.67-0.91), Piccini said.
The researchers concluded that, based upon their data, remote monitoring use is associated with 9,810 fewer hospitalizations and 119,000 fewer hospital days and saves $370,270,000 per 100,000 patient-years. “There are estimated to be 4 million patients with implanted devices in the United States, so you can see how those numbers multiply even further,” Piccini said.
“We learned that … in routine clinical practice, remote monitoring is associated with improved clinical outcomes, and those improved clinical outcomes were associated with significant decreases in expenditures for all-cause hospitalization,” Piccini said. “We also found that this benefit does not appear to be restricted to one type of device.”
In advance of the scientific sessions, the HRS issued a scientific statement recommending that remote monitoring be the standard of care for all patients with implantable cardiac devices. - by Erik Swain
Reference:
Piccini JP, et al. Abstract LBCT01-01. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 13-16, 2015; Boston.
Disclosure: Piccini reports receiving consulting fees/honoraria from Medtronic and a research grant from Boston Scientific.
Perspective
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Jonathan M. Kalman, MBBS, PhD, FHRS
I absolutely think this helps put to bed the question of whether remote monitoring should be used. There are strong data that remote monitoring is beneficial for our patients in a number of different ways. That’s why the HRS has come out with a Class I recommendation for remote monitoring. My personal experience has been that it is a major innovation in the way we manage device patients. We detect significant problems early. I’m not surprised that that flows to better outcomes.
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