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Type: Journal article
Title: Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes
Author: Parthiban, N.
Esterman, A.
Mahajan, R.
Twomey, D.
Pathak, R.
Lau, D.
Roberts-Thomson, K.
Young, G.
Sanders, P.
Ganesan, A.
Citation: Journal of the American College of Cardiology, 2015; 65(24):2591-2600
Publisher: Elsevier
Issue Date: 2015
ISSN: 0735-1097
Statement of
Nirmalatiban Parthiban, Adrian Esterman, Rajiv Mahajan, Darragh J. Twomey, Rajeev K. Pathak, Dennis H. Lau, Kurt C. Roberts-Thomson, Glenn D. Young, Prashanthan Sanders, Anand N. Ganesan
Abstract: BACKGROUND: Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. OBJECTIVES: This study sought to conduct a systematic literature review and meta-analysis of RCTs comparing RM with IO follow-up. METHODS: Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. RESULTS: In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). CONCLUSIONS: Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
Keywords: home monitoring
sudden cardiac death
Rights: © 2015 by the American College of Cardiology Foundation.
DOI: 10.1016/j.jacc.2015.04.029
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