Affiliation:
1. Heart Institute, University of Pécs, Medical School, Hungary
2. Bioanalytical Institute, University of Pécs, Medical School, Hungary
3. Szentagothai Research Centre, University of Pécs, Hungary
Abstract
IntroductionThe impact of remote monitoring (RM) on clinical outcomes in
heart failure (HF) patients with cardiac resynchronisation therapy-defibrillator (CRT-D) implantation is controversial. This study sought to evaluate
the performance of an RM follow-up protocol using modified criteria of the
PARTNERS HF trial in comparison with a conventional follow-up scheme.Material and methodsWe compared cardiovascular (CV) mortality (primary
endpoint) and hospitalisation events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted
patients with automatic RM utilising daily transmissions (RM group, n = 45)
and conventional follow-up (CFU group, n = 43) in a single-centre observational study.ResultsAfter a median follow-up of 25 months, a significant advantage
was seen in the RM group in terms of CV mortality (1 vs. 6 death event,
p = 0.04), although RM follow-up was not an independent predictor for CV
mortality (HR = 0.882; 95% CI: 0.25–3.09; p = 0.845). Patient CV mortality
was independently influenced by hospitalisation events for decompensated
HF (HR = 3.24; 95% CI: 8–84; p = 0.022) during follow-up. We observed
significantly fewer hospitalisation events for decompensated HF (8 vs. 29
events, p = 0.046) in the RM group. Furthermore, a decreased number of
total (161 vs. 263, p < 0.01) and unnecessary ambulatory in-office visits
(6 vs.19, p = 0.012) were seen in the RM group as compared to the CFU group.ConclusionsFollow-up of CRT-D patients using automatic RM with daily
transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival.
Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional
follow-up.
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