Remote Monitoring of Implantable Devices Benefits Hearts, Hospitals and Wallets

A new analysis finds that remote monitoring of implantable devices can significantly improve outcomes and reduce costs for patients with atrial fibrillation (AF) and several other conditions.

Investigators used the Truven Health Analytics MarketScan database to pull records for 92,566 patients who received an implant between March, 2009 and April, 2012. They then compared outcomes and costs over a mean follow-up period of 19 months (± a standard deviation of 12 months) for the 37% of all patients who were then monitored remotely and the 63% of patients who were not.

Both patient groups had similar Charlson comorbidity scores, but those who were monitored remotely had lower all-cause hospitalization (adjusted hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.80-0.84; p<0.001). Among patients who received an implant for AF, those who were routinely monitored remotely were significantly less likely than those who were not to be hospitalized for stroke.

When patients were hospitalized, those who were monitored remotely tended to get out faster (5.3 vs 8.1 days, p<0.001). Overall, remote monitoring was associated with 9,810 fewer hospitalizations and 119,000 fewer days in hospital.

Fewer days in the hospital equated to 30% lower hospitalization costs for patients in the remote monitoring group ($8,720 vs $12,423 mean cost per patient-year). In all, remote monitoring saved more than $370 million in hospital payments.

“Remote monitoring is associated with reductions in hospitalization and healthcare utilization,” the study authors wrote in HeartRhythm. “Since only about a third of cardiac implantable electronic device patients routinely utilize remote monitoring, this represents a major opportunity for quality improvement.”

The total cohort was 63% male, and the average age of its members was 72 years (± 13 years). Some 54,520 of them (59%) had received a pacemaker, while 27,816 (30%) had received an implantable cardioverter defibrillator and 10,230 (11%) had received a cardiac resynchronization device.

Many healthcare providers have the ability to use remote monitoring more frequently than they do. A 2013 survey published in Europace found that 76.8% of all participating medical centers used it, at least occasionally, with implantable cardioverter defibrillators or cardiac resynchronization therapy devices. That said, only 32.6% of those medical centers reported that they systematically made frequent use of the technology to detect AF in patients with either type of device.

“The judgement about the value of the remote information about AF is still surprising: only 50—60% of centers think that this information is useful for a decision whether to commence anticoagulation, optimize rate control, or optimize device programming to avoid inappropriate shocks,” the survey team wrote.

A number of studies have found significant value in remote monitoring. For example, a piece published in The New England Journal of Medicine reported on the results of the CRYSTAL AF trial in patients who had suffered cryptogenic stroke.

In that study, after 6 months of follow-up, AF had been detected in 8.9% of patients in an implantable cardiac monitor group (19 patients) versus 1.4% of patients in the control group using conventional AF detection (3 patients) (hazard ratio [HR], 6.4; 95% CI, 1.9 to 21.7; P<0.001).

By 12 months, AF had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (HR, 7.3; 95% CI, 2.6 to 20.8; P<0.001).

The study authors noted that their results suggested that the detection of a single case of AF within a 6-month window would require, on average, that doctors implant devices in 14 patients. The detection of a single case within a 3-year window would require 4 devices.