Remote Monitoring of Implantable Cardioverter-Defibrillators : A Systematic Review and Meta-Analysis of Clinical Outcomes

This article is a systematic review of the randomized controlled trials comparing Remote Monitoring (RM) with In-office (IO) follow-up of implantable cardioverter-defibrillators (ICD).

Background

Implantable cardioverter-defibrillators (ICD) have become the standard of care therapy for primary and secondary prevention of sudden cardiac death. Remote monitoring (RM) of ICD devices has been proposed as an alternative strategy to reduce the need for routine device follow-up visits while providing continuous surveillance and immediate problem notification. ICDs can be interrogated automatically using wireless data transfer to the remote monitor by treating clinicians through an Internet-based interface or provide automatically generated clinician alerts.In the current study, the authors conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) comparing clinical outcomes in ICD patients undergoing RM with those receiving conventional IO follow-up.

Method

The authors conducted a systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane databases to identify RCTs comparing RM with conventional IO follow-up in ICD patients. Statistical analysis was performed with Comprehensive Meta-Analysis. A total of 4,376 citations were retrieved, then 3,491 citations were excluded after initial screening. Of 885 citations selected for a secondary review, the authors identified 20 journal articles referencing 9 published RCTs. A total of 6,469 patients were included in the 9 RCTs, all published in the years 2010 through 2014.

Results

An important potential clinical advantage of remote device monitoring identified in observational studies is the potential for a reduction in hospitalization. A potential advantage for RM is its ability for continuous surveillance to identify problems early, thereby minimizing adverse outcomes including shocks. A significant reduction in inappropriate shocks was recorded in the 3 RCTs. Possible reasons for this could include earlier detection of device/lead abnormalities or timely detection and treatment of atrial arrhythmias.

Conclusion

Remote Monitoring of ICD patients is done in primary care practices around the world. This meta-analysis of randomized controlled trials demonstrates benefits related to mortality, patient safety and survival due to rapid clinical event detection and a reduction in inappropriate shocks.

Comments

Remote monitoring is used for chronic disease management in patients. RM is done using devices that collect Patient vitals such as BP, weight, glucose levels and transfer it to physician practice systems. Similarly, Remote monitoring of Implantable cardioverter-defibrillators (ICD) can be used for preventive care and chronic disease management, improving patient safety.