Remote CareLink Monitoring Speeds Up Clinical Decision-making

Study results presented at the 59th Annual Scientific Session of the American College of Cardiology showed that remote monitoring of patients who have an implantable cardioverter-defibrillator (ICD) achieved shorter times to clinical decision-making compared with standard office visits in the CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial.

The trial showed that the time from a clinical event such as arrhythmias, cardiovascular disease progression, and device problems to the physician’s clinical decision was reduced from 22 days for patients monitored during a standard office visit to 4.6 days with remote monitoring (P<.001). Further, the mean length of cardiovascular hospital stay was reduced from 4 days in the standard office-visit arm to 3.3 days in the remote arm (P=.002), reducing costs of cardiovascular hospitalization by an estimated $1659.00 per hospitalization.

Even though the results strongly favor remote monitoring of ICD, the CONNECT investigators were disappointed with the 4.6-day time to decision-making once an alert was remotely transmitted. Lead investigator, George H. Crossley, MD, of St Thomas Research Institute and Saint Thomas Heart at Baptist Hospital in Nashville, TN, explained that there was a lag time in the remote monitoring arm of the trial due to two problems: patients were randomized to either arm immediately after they left the hospital with an implanted ICD, but some remote systems were installed 30 days later. Additionally, many remote systems were recalled to replace a faulty lead. Crossley presented the CONNECT results at a late-breaking clinical trials session during the 59th Annual Scientific Session of the American College of Cardiology.

CONNECT randomized 1997 patients with a newly implanted ICD recruited at 136 U.S. centers to either the remote monitoring arm or in-office monitoring every 3 months. Patients were followed for 12 months. The demographics of both groups were similar: mean age, 65 years; 70% male; and mean ejection fraction, 30%. Patients were predominantly NYHA Class II and III heart failure. They were monitored remotely for atrial tachycardia/atrial fibrillation, ventricular tachycardia, and device problems.

Among those randomized to the remote system, 41% had a successful alert transmission, 12% had a successful alert transmission but the patient was seen by the doctor prior to viewing device data, 13% came to the office before an alert transmission, 25% were unable to transmit because the monitor was not properly installed in the home, and in 9% the clinical alert did not occur because the monitor was unplugged.

The Medtronic CareLink Network, the remote monitoring system used in the study, utilizes wireless technology to transmit data from a portable monitor that is connected to a standard telephone line. Problem alerts are communicated to the doctor’s office by beeper or cell phone. The study was supported by Medtronic.