Impact of Remote Monitoring on Long-Term Prognosis in Heart Failure Patients in a Real-World Cohort: Results From All-Comers COMMIT-HF Trial.

Abstract

BACKGROUND:

Randomized controlled trials demonstrate that remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT-Ds) may improve quality of care and prognosis in heart failure (HF) patients. However, the impact of RM on long-term mortality in a real-world cohort is still not well examined.

METHODS AND RESULTS:

This study was designed as a matched cohort study based on the COMMIT-HF trial--a single-center, ongoing prospective observational registry (NCT02536443). Complete patient demographics, medical history, in-hospital results, hospitalizations, and mortality data were collected based on institutional registries and healthcare providers' records. Patients were divided into 2 groups based on RM presence and matched by means of propensity scores according to clinical characteristics. The primary endpoint of this study was the long-term all-cause mortality. Out of 1,429 consecutive patients, 822 patients with a first implantation of an ICD/CRT-D were included in the analysis. The final matched study population contained 574 patients in RM and in a control group. Although demographic and echocardiographic parameters as well as pharmacological treatments were similar in both groups, a significantly lower 1-year mortality was detected in the RM group (2.1% vs. 11.5%, P < 0.0001). This was also maintained during a 3-year follow-up (4.9% vs. 22.3%, P < 0.0001). Multivariate analysis showed that RM was associated with an improved prognosis (hazard ratio 0.187, 95% confidence interval 0.075-0.467, P = 0.0003).

CONCLUSION:

RM of HF patients with ICDs/CRT-Ds significantly reduced long-term mortality in a real-world clinical condition.

• Authors: Anna Kurek, Mateusz Tajstra, Elzbieta Gadula-Gacek, Piotr Buchta, Michal Skrzypek, Lukasz Pyka, Michal Wasiak, Malgorzata Swietlinska, Michal Hawranek, Lech Polonski, Mariusz Gasior, Jedrzej Kosiuk
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 28 Issue 4 Pg. 425-431 (Apr 2017) ISSN: 1540-8167 [Electronic] United States
• PMID: 28176442 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2017 Wiley Periodicals, Inc.

Topics

• Aged
• Cardiac Resynchronization Therapy
• Cardiac Resynchronization Therapy Devices
• Chi-Square Distribution
• Defibrillators, Implantable
• Electric Countershock (instrumentation)
• Female
• Heart Failure (diagnosis, mortality, physiopathology, therapy)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Prognosis
• Propensity Score
• Proportional Hazards Models
• Prospective Studies
• Prosthesis Design
• Registries
• Risk Factors
• Telemedicine (methods)
• Telemetry
• Time Factors