Remote monitoring and outcomes in heart failure: 5-year study.

Over a 5-year follow-up period, 68 deaths and 190 cardiovascular events occurred among 402 remotely monitored patients with ICDs or CRT-Ds.

• Total study population: N = 402 patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators
• N = 68 deaths occurred over the 5-year follow-up
• N = 190 cardiovascular events (defined as hospitalization or death) occurred over the 5-year follow-up
• Clinical data were sourced from the Electrophysiology Registry of the Cardiology Unit
• Patients were managed via remote monitoring throughout the follow-up period

Ischemic disease, age at least 75 years, atrial fibrillation, and severe chronic kidney disease were statistically significant risk factors for both death and cardiovascular events by Kaplan-Meier analysis.

• Univariate survival analyses were performed based on four patient characteristics: ischemic disease, age over 75 years, atrial fibrillation, and severe chronic kidney disease (CKD)
• Log-rank test P < 0.001 for all four risk factors for both death and cardiovascular events
• Kaplan-Meier analysis was the method used for these univariate survival analyses

Cox regression multivariate analysis confirmed that ischemic disease, age ≥75 years, atrial fibrillation, CRT-D implantation, and severe CKD were all independently associated with significantly higher risk of cardiovascular events and mortality.

• Five independent risk factors were identified in the multivariate model: ischemic disease, age 75 years and older, atrial fibrillation, implantation with a CRT-D device, and severe CKD
• Cox proportional hazards regression was the multivariate method employed
• CRT-D device implantation (compared to ICD alone) emerged as an additional significant risk factor in the multivariate model that was not included in the initial univariate analyses
• All five factors were associated with 'significantly higher risk of cardiovascular events and mortality'

The clinical burden of heart failure in patients with CIEDs under remote monitoring remains substantial despite the proven effectiveness of remote monitoring.

• The study authors conclude that 'continuous enhancements are necessary to facilitate early intervention and improve outcomes for these high-risk groups'
• The study population comprised patients with chronic conditions managed with cardiac implantable electronic devices (CIEDs)
• The study period spanned 5 years of follow-up with remote monitoring in place throughout