The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients.

نویسندگان

  • Niraj Varma
  • Jonathan P Piccini
  • Jeffery Snell
  • Avi Fischer
  • Nirav Dalal
  • Suneet Mittal
چکیده

BACKGROUND Remote monitoring (RM) technology embedded within cardiac rhythm devices permits continuous monitoring, which may result in improved patient outcomes. OBJECTIVES This study used "big data" to assess whether RM is associated with improved survival and whether this is influenced by the type of cardiac device and/or its degree of use. METHODS We studied 269,471 consecutive U.S. patients implanted between 2008 and 2011 with pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy (CRT) with pacing capability (CRT-P)/defibrillation capability (CRT-D) with wireless RM. We analyzed weekly use and all-cause survival for each device type by the percentage of time in RM (%TRM) stratified by age. Socioeconomic influences on %TRM were assessed using 8 census variables from 2012. RESULTS The group had implanted PMs (n = 115,076; 43%), ICDs (n = 85,014; 32%), CRT-D (n = 61,475; 23%), and CRT-P (n = 7,906; 3%). When considered together, 127,706 patients (47%) used RM, of whom 67,920 (53%) had ≥75%TRM (high %TRM) and 59,786 (47%) <75%TRM (low %TRM); 141,765 (53%) never used RM (RM None). RM use was not affected by age or sex, but demonstrated wide geographic and socioeconomic variability. Survival was better in high %TRM versus RM None (hazard ratio [HR]: 2.10; p < 0.001), in high %TRM versus low %TRM (HR: 1.32; p < 0.001), and also in low %TRM versus RM None (HR: 1.58; p < 0.001). The same relationship was observed when assessed by individual device type. CONCLUSIONS RM is associated with improved survival, irrespective of device type (including PMs), but demonstrates a graded relationship with the level of adherence. The results support the increased application of RM to improve patient outcomes.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Remote Monitoring of Implantable Cardioverter-Defibrillator Therapy

With increasing awareness of the indications of implantable cardioverter defibrillator (ICD) therapy, the number of patients with ICDs has been growing rapidly. Patient with an ICD require high-quality care and intense follow-up to ensure safe and effective device performance. Given the expanding use and the complexity of these devices, there has been an urgent need to improve the safety and co...

متن کامل

Comparison of the effect of training by video and group discussion on the level of stress, anxiety, depression and self-efficacy of patients undergoing pacemaker and cardiac implantation defibrillator

متن کامل

Is correction for metallic artefacts mandatory in cardiac SPECT/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?

Introduction: Metallic artifacts due to pacemaker/ implantable cardioverter defibrillator (ICD) leads in CT images can produce artifactual uptake in cardiac SPECT/CT images. The aim of this study was to determine the influence of the metallic artifacts due to pacemaker and ICD leads on myocardial SPECT/CT imaging. Methods: The study included 9 patients wh...

متن کامل

Current clinical evidence for remote patient management.

Pacemaker (PM) and implantable cardioverter defibrillator (ICD) patients are ideally suited to remote management in the form of remote follow-up as well as of remote monitoring, which are both acts of telemedicine. Large randomized trials, such as TRUST, COMPAS, CONNECT, ECOST and EVOLVO, and the huge ALTITUDE registry provided a high level of evidence for the multiple advantages of remote mana...

متن کامل

ارتباط تبعیت از رژیم دارویی با کیفیت زندگی بیماران پیوند کلیه

  Background and Aim: Post-kidney transplant survival relies on patient adherence to the intake of immunosuppressive medication. Non-adherence to immunosuppressive drugs leads to rejection, graft loss, dialysis, lower quality of life, increased costs and mortality. Quality of life may be useful to identify non-adherence. The aim of the current study was to examine the relationship between medic...

متن کامل

ذخیره در منابع من

ذخیره در منابع من قبلا به منابع من ذحیره شده

{@ msg_add @}


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Journal of the American College of Cardiology

دوره 65 24  شماره 

صفحات  -

تاریخ انتشار 2015