Remote monitoring: Does more patient data really improve outcomes?
Two new studies call into question whether remote monitoring improved outcomes for heart failure (HF) patients.
One study, the Remote Management of Heart Failure Using Implantable Electronic Devices (REM-HF) trial, suggested that remote monitoring of HF heart failure patients with cardiac implantable electronic devices (CEIDs) may not be associated with reduced mortality or fewer cardiovascular hospitalizations compared to usual care.
“Results from this trial, in a setting intended to maximize the benefit of remote monitoring, do not support its routine use in the management of patients with CIEDs,” said Martin Cowie, MD, from Imperial College London, co-principal investigator of the study. “The assumption that ‘more data improves outcomes’ is not true. If patients are well-treated already, and have well-controlled symptoms, looking at remotely collected data weekly is no better than usual care.”
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The second study, called the Monitoring Resynchronization Devices and Cardiac Patients (MORE-CARE) Randomized Controlled Trial, found remote monitoring of HF patients who were fitted with biventricular defibrillators (CRT-D) may not improve outcomes compared to those whose devices were monitored during in-clinic visits.
In the MORE-CARE Trial, 900 HF patients implanted with a CRT-D with wireless transmission capabilities were randomized within eight weeks of device implantation to receive remote monitoring of their device alternating with in-office visits or to have all their checks done in-office.
After a median follow-up of 24 months. there was no significant difference in the rate of the primary endpoint of mortality and hospitalizations for cardiovascular or device-related reasons (29.7 percent in the remote group and 28.7 percent in the standard care group).
The results suggest “there may be a valid reason for implementing remote monitoring despite the lack of impact on hard clinical outcomes,” said lead investigator Giuseppe Boriani, MD.
“Health care resource utilization for cardiovascular reasons was 38 percent lower in the remote versus the standard care arm, and there was an estimated cost-saving that went along with that – both from the perspective of the health care system, but also in terms of personal patient travel costs,” Boriani said.
Both studies were presented Aug. 28 during ESC Congress 2016 in Rome.