Remote monitoring helpful in decision-making for cardiac patients

April 15, 2010

Remote monitoring reduced the median time to clinical decision compared with standard in-office follow-up for patients with cardiac resynchronization therapy defibrillators or implantable cardioverter-defibrillators, according to results of the prospective Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision trial recently released during the American College of Cardiology annual meeting.

Remote monitoring reduced the median time to clinical decision compared with standard in-office follow-up for patients with cardiac resynchronization therapy (CRT) defibrillators or implantable cardioverter-defibrillators (ICDs), according to results of the prospective CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial recently released during the American College of Cardiology annual meeting. The study specifically involved the Medtronic CareLink Network.

The CONNECT trial randomly assigned to remote monitoring or standard in-office care about 2,000 patients in whom an ICD with or without CRT capabilities had been implanted at one of 136 sites in the United States. All patients were followed for 15 months after device implantation.

Results of the research demonstrated that the time from a patient's clinical event (arrhythmia, cardiovascular disease progression, or device issue) to the physician's clinical decision was 4.6 days for patients in the remote monitoring group versus 22 days for those monitored in-office.

Data showed that replacing routine in-clinic visits with remote monitoring did not significantly increase emergency room visits, cardiovascular hospitalizations, or unscheduled clinic visits. Data also showed a statistically significant decrease in mean length of cardiovascular hospital stays to 3.3 days in the remote monitoring arm from four days in the in-office arm. Due to the shorter length of stay, cardiovascular hospitalization costs were reduced by an estimated $1,659 per hospitalization for the remotely monitored patients.

"The CONNECT data showed remote monitoring . . . not only significantly reduced the time to clinical decision but also may reduce the need for standard in-clinic visits, which may not always be necessary for the patient and often place added burden on the physician's clinic," says George H. Crossley, MD, FACC, of the Saint Thomas Research Institute and Saint Thomas Heart at Baptist Hospital in Nashville. "At the same time, these data lead us to believe there may be other potential benefits of remote monitoring, including a reduction in mean length of stay for cardiovascular hospitalizations, which may have an economic impact on the patient and the healthcare system."

The patients monitored remotely were given Medtronic's wireless remote management system to transmit device information to physicians' offices. The system uses wireless telemetry to permit the automatic transmission of diagnostics to physicians without the need for patient intervention. The patients receiving in-office care were followed at a fixed standard-of-care schedule without remote monitoring.