Department of Cardiology Massachusetts General Hospital Boston MA.
Harvard Medical School Cambridge MA.
J Am Heart Assoc. 2023 Feb 7;12(3):e027500. doi: 10.1161/JAHA.122.027500. Epub 2023 Jan 23.
Background Remote monitoring (RM) of cardiac implantable electronic devices has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in use and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in cardiac implantable electronic device RM. Methods and Results This was a retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted cardiac implantable electronic device or device upgrade between January 2017 and December 2020 were included. Patients were classified as RM positive (RM+) when they underwent at least ≥2 remote interrogations per year during follow-up. Of all eligible patients, 2520 patients were included, and 34% were women. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, whereas 26% were implantable cardioverter-defibrillators, and 8% were cardiac resynchronization therapy with implantable cardioverter-defibrillators. Most patients (83%) were of European American ancestry. During follow-up, 66% of patients were classified as RM+. Patients who were younger, European American, college-educated, lived in a county with higher median household income, and were active on the hospital's patient portals were more frequently RM+. In an adjusted regression model, RM+ remained associated with the use of the online patient portal (odds ratio [OR], 2.889 [95% CI, 2.387-3.497]), presence of an implantable cardioverter-defibrillator (OR, 1.489 [95% CI, 1.207-1.835]), advanced college degree (OR, 1.244 [95% CI, 1.014-1.527]), and lastly with European American ancestry (<0.05). During the years of the COVID-19 pandemic, the number of RM+ patients increased, whereas the association with ancestry and ethnicity decreased. Conclusions Despite being offered to all patients at implantation, significant disparities were present in cardiovascular implantable electronic device RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center- and patient-specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.
背景 心脏植入式电子设备的远程监测 (RM) 已被证明可改善心血管发病率和死亡率。迄今为止,尚无研究调查 RM 使用和提供方面的种族和社会经济差异。本研究旨在调查心脏植入式电子设备 RM 是否存在种族和社会经济差异。
方法和结果 这是在美国一家三级保健中心进行的回顾性观察队列研究。纳入 2017 年 1 月至 2020 年 12 月期间新植入心脏植入式电子设备或设备升级的患者。在随访期间至少每年进行≥2 次远程询问的患者被归类为 RM 阳性 (RM+)。在所有符合条件的患者中,有 2520 例患者被纳入,其中 34%为女性。平均随访时间为 25 个月。平均年龄为 71±14 岁。植入设备中 66%为起搏器,26%为植入式心律转复除颤器,8%为心脏再同步治疗联合植入式心律转复除颤器。大多数患者 (83%)为欧洲裔美国人。随访期间,66%的患者被归类为 RM+。年龄较小、欧洲裔美国人、受过大学教育、居住在家庭中位收入较高的县以及使用医院患者门户的患者,RM+的可能性更高。在调整后的回归模型中,RM+仍与使用在线患者门户相关(优势比 [OR],2.889 [95%置信区间,2.387-3.497])、植入式心律转复除颤器的存在(OR,1.489 [95%置信区间,1.207-1.835])、高级大学学位(OR,1.244 [95%置信区间,1.014-1.527]),最后是欧洲裔美国人血统(<0.05)。在 COVID-19 大流行期间,RM+患者的数量增加,而与种族和民族的关联减少。
结论 尽管在植入时向所有患者提供了 RM,但在该队列中,心血管植入式电子设备的 RM 仍存在显著差异。在 COVID-19 期间,这些差异部分得到了扭转。需要进一步研究以检查卫生中心和患者特定因素,以克服这些障碍,并促进平等机会参与 RM。