TY - JOUR
T1 - Remote Monitoring of Implantable Cardioverter-Defibrillators
T2 - A Systematic Review and Meta-Analysis of Clinical Outcomes
AU - Parthiban, Nirmalatiban
AU - Esterman, Adrian
AU - Mahajan, Rajiv
AU - Twomey, Darragh J.
AU - Pathak, Rajeev K.
AU - Lau, Dennis H.
AU - Roberts-Thomson, Kurt C.
AU - Young, Glenn D.
AU - Sanders, Prashanthan
AU - Ganesan, Anand N.
N1 - Funding Information:
Drs. Mahajan and Pathak are supported by the Australian Postgraduate Award from the University of Adelaide. Drs. Mahajan, Twomey, and Pathak are supported by the Leo J. Mahar Electrophysiology Scholarship from the University of Adelaide. Dr. Lau is supported by a Postdoctoral Fellowship from the National Health and Medical Research Council of Australia. Dr. Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia, and the National Heart Foundation of Australia; has served on the advisory board of Biosense-Webster, Medtronic, St. Jude Medical, Sanofi, and Merck, Sharpe and Dohme; has received lecture and/or consulting fees from Biosense-Webster, Medtronic, St. Jude Medical, Boston Scientific, Merck, Sharpe and Dohme, Biotronik, and Sanofi; and has received research funding from Medtronic , St. Jude Medical , Boston Scientific , Biotronik , and Sorin . Dr. Ganesan is supported by an Australian Early Career Health Practitioner Fellowship from the National Health and Medical Research Council of Australia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2015/6/23
Y1 - 2015/6/23
N2 - Abstract Background Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. Objectives This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up. Methods Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. Results In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). Conclusions Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
AB - Abstract Background Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. Objectives This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up. Methods Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. Results In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). Conclusions Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
KW - home monitoring
KW - mortality
KW - shock
KW - sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=84931576487&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2015.04.029
DO - 10.1016/j.jacc.2015.04.029
M3 - Article
C2 - 25983009
AN - SCOPUS:84931576487
VL - 65
SP - 2591
EP - 2600
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 24
M1 - 21287
ER -