Department of Medicine, University of California, San Francisco, San Francisco, California.
Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon.
Heart Rhythm. 2022 Sep;19(9):1499-1507. doi: 10.1016/j.hrthm.2022.04.025. Epub 2022 Apr 29.
Professional societies strongly recommend remote monitoring (RM) of all cardiac implantable electronic devices, and higher RM adherence is associated with improved patient outcomes. However, adherence with RM is suboptimal.
The purpose of this study was to better understand factors associated with RM adherence.
We linked RM data from the Veterans Affairs National Cardiac Device Surveillance Program to clinical data for patients monitored between October 25, 2018, and October 24, 2020. RM adherence was defined as the percentage of days covered by an RM transmission during the study period. Patients were classified into 3 categories: complete (100% of days covered by an RM transmission), intermediate (above median in patients with <100% adherence), and low (below median in patients with <100% adherence) adherence. We used multivariable logistic regression to examine patient, device, and facility characteristics associated with adherence.
In 52,574 patients, average RM adherence was 71.9%. Only 30.9% (16,224) of patients had complete RM adherence. Black or African American patients had a lower odds of complete RM adherence than white patients (odds ratio 0.88; 95% confidence interval 0.82-0.94), and Hispanic or Latino patients had a lower odds of complete RM adherence (odds ratio 0.79; 95% confidence interval 0.70-0.89) than non-Hispanic or Latino patients. Dementia, depression, and posttraumatic stress disorder were associated with a lower odds of RM adherence.
There are significant disparities in RM adherence by race, ethnicity, and neuropsychiatric comorbidities. These findings can inform strategies to improve health equity and ensure that all patients with cardiac implantable electronic devices receive the evidence-based clinical benefits of RM.
专业协会强烈建议对所有心脏植入式电子设备进行远程监测（RM），并且更高的 RM 依从性与改善患者预后相关。然而，RM 的依从性并不理想。
本研究旨在更好地了解与 RM 依从性相关的因素。
我们将退伍军人事务部国家心脏设备监测计划中的 RM 数据与 2018 年 10 月 25 日至 2020 年 10 月 24 日期间接受监测的患者的临床数据进行了关联。RM 依从性定义为研究期间 RM 传输覆盖的天数百分比。患者被分为 3 类：完全（RM 传输覆盖的天数百分比为 100%）、中等（低于 100%依从性的患者中中位数以上）和低（低于 100%依从性的患者中中位数以下）。我们使用多变量逻辑回归来检查与依从性相关的患者、设备和设施特征。
在 52574 名患者中，平均 RM 依从性为 71.9%。只有 30.9%（16224 名）的患者完全依从 RM。与白人患者相比，黑人和非裔美国患者完全依从 RM 的可能性较低（优势比 0.88；95%置信区间 0.82-0.94），而西班牙裔或拉丁裔患者完全依从 RM 的可能性也较低（优势比 0.79；95%置信区间 0.70-0.89）非西班牙裔或拉丁裔患者。痴呆、抑郁和创伤后应激障碍与 RM 依从性降低相关。
RM 依从性在种族、民族和神经精神合并症方面存在显著差异。这些发现可以为改善健康公平和确保所有植入心脏电子设备的患者获得 RM 的循证临床益处的策略提供信息。
