Varma Niraj, Marijon Eloi, Vicaut Éric, Boveda Serge, Abraham Alexandre, Ibnouhsein Issam, Rosier Arnaud, Defaye Pascal, Singh Jagmeet P
Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic London, London, United Kingdom.
Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Heart Rhythm. 2024 Nov 22. doi: 10.1016/j.hrthm.2024.11.029.
Adherence to recommended follow-up schedules for remote monitoring (RM) of patients with implantable cardioverter-defibrillators (ICDs) is inconsistent, which may influence clinical outcomes. Systematic organization through a "third-party" universal monitoring system (UMS) may be beneficial.
We aimed to evaluate the clinical impact of RM and any incremental benefit of UMS vs conventional RM.
In the comprehensive French nationwide health database, we identified 69,394 ICD patients (67.9 ± 13.4 years; male, 77.5%; 34.9% defibrillator with cardiac resynchronization therapy) with clinical data. Hospitalizations and survival were assessed for 1 year (2019). Patients were classified by RM status (no-RM and RM), then RM separated further by follow-up method (conventional manufacturer-specific RM or UMS). Adjusted annual mortality rates and hospitalizations (all-cause, heart failure, number, and duration) were compared in no-RM vs RM, then conventional RM vs UMS.
Mortality rate was reduced in RM vs no-RM (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.95-0.97; P < .001). In RM, all-cause hospitalizations increased in number but their cumulative duration diminished (HR, 0.98; 95% CI, 0.98-0.99; P < .001). Compared with conventional RM, UMS was associated with reduced rates of mortality (HR, 0.74; 95% CI, 0.73-0.77; P < .001), all-cause and heart failure hospitalizations (HR, 0.96; 95% CI, 0.95-0.97; P < .001), and hospital stay duration (HR, 0.96; 95% CI, 0.95-0.97; P < .001).
RM was associated with improved survival in ICD recipients. Importantly, we found that use of UMS was associated with additional improvement in clinical outcomes, including survival and hospitalizations. These observations point to organizational challenges in conventionally managed RM that can be mitigated by a universal monitoring platform.
对于植入式心脏复律除颤器（ICD）患者，遵循推荐的远程监测（RM）随访计划的情况并不一致，这可能会影响临床结局。通过“第三方”通用监测系统（UMS）进行系统组织可能有益。
我们旨在评估RM的临床影响以及UMS相较于传统RM的任何额外益处。
在法国全国综合健康数据库中，我们识别出69394例有临床数据的ICD患者（年龄67.9±13.4岁；男性占77.5%；34.9%的除颤器带有心脏再同步治疗）。评估了2019年1年的住院情况和生存率。患者按RM状态（无RM和RM）分类，然后RM再根据随访方法（传统的特定制造商RM或UMS）进一步细分。比较无RM与RM、传统RM与UMS的调整后年死亡率和住院情况（全因、心力衰竭、次数和时长）。
与无RM相比，RM的死亡率降低（风险比[HR]，0.96；95%置信区间[CI]，0.95 - 0.97；P <.001）。在RM中，全因住院次数增加但其累计时长减少（HR，0.98；95%CI，0.98 - 0.99；P <.001）。与传统RM相比，UMS与死亡率降低相关（HR，0.74；95%CI，0.73 - 0.77；P <.001），全因和心力衰竭住院情况（HR，0.96；95%CI，0.95 - 0.97；P <.001）以及住院时长（HR，0.96；95%CI，0.95 - 0.97；P <.001）降低相关。
RM与ICD接受者生存率提高相关。重要的是，我们发现使用UMS与临床结局的进一步改善相关，包括生存率和住院情况。这些观察结果指出了传统管理的RM中存在的组织挑战，而通用监测平台可以缓解这些挑战。
