Long-term clinical outcomes of remote monitoring for implantable cardioverter-defibrillators in Singapore.

Vern Hsen Tan, Khi Yung Fong, Lisa Jie Ting Teo, Deborah Wai Yi Lo, Fiona Wan Qi Ku, Yiong Huak Chan, Yue Wang, Colin Yeo, Chi Keong Ching, Toon Wei Lim
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Abstract

Introduction: Remote monitoring (RM) for cardiac implantable electronic devices is on the rise and has been shown to reduce the burden of in-clinic follow-up visits. We aimed to investigate the long-term clinical outcomes of RM versus no RM.

Methods: This was a prospective, single-centre cohort study of consecutive patients with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy-defibrillator (CRT-D) followed up from 2018 to 2023. Patients who received non-ICD devices were excluded. In general, RM was offered to all patients, but uptake depended on patient preference. For data analysis, patients were stratified according to whether RM was used. The primary outcome was all-cause mortality; secondary outcomes were hospitalisation for heart failure and device therapy (shocks and electrical storm).

Results: Of 551 patients, 284 (51.5%) received RM and 267 (49.5%) did not. Baseline demographics were similar between the two arms. All-cause mortality was significantly lower in RM versus non-RM patients (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.33-0.60, P <0.001), as was hospitalisation for heart failure (HR 0.39, 95% CI 0.25-0.59, P <0.001); these remained significant after adjustment for baseline covariates. More patients on RM received appropriate antitachycardia pacing (ATP) (17.6% vs. 10.7%, P = 0.035) and appropriate shocks (24.1% vs. 14.7%, P = 0.017). The incidences of inappropriate ATP, inappropriate shocks and electrical storm were similar. More patients on RM underwent pulse generator change (34.1% vs. 10.1%, P <0.001).

Conclusion: Remote monitoring was associated with significantly lower mortality in both ICDs and CRT-Ds and in primary and secondary indications, as well as fewer heart failure hospitalisations. This supports current guidelines recommending the use of RM in all patients with ICD or CRT-D.

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新加坡植入式心律转复除颤器远程监控的长期临床效果。
导言:心脏植入式电子设备的远程监测(RM)正在兴起,并被证明可减轻门诊随访的负担。我们的目的是研究远程监护与不进行远程监护的长期临床效果:这是一项前瞻性、单中心队列研究,研究对象为植入式心律转复除颤器(ICD)或心脏再同步治疗-除颤器(CRT-D)的连续患者,随访时间为2018年至2023年。接受非 ICD 设备的患者不包括在内。一般来说,所有患者均可接受RM治疗,但是否接受取决于患者的偏好。在进行数据分析时,根据是否使用RM对患者进行了分层。主要结果为全因死亡率;次要结果为心力衰竭住院和装置治疗(电击和电风暴):551名患者中,284人(51.5%)接受了RM治疗,267人(49.5%)未接受RM治疗。两组患者的基线人口统计学特征相似。RM患者的全因死亡率明显低于非RM患者(危险比[HR]0.45,95%置信区间[CI]0.33-0.60,P结论):无论是 ICD 还是 CRT-D,无论是主要适应症还是次要适应症,远程监测都能显著降低死亡率,并减少心衰住院次数。这支持了目前建议所有 ICD 或 CRT-D 患者使用 RM 的指南。
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