title: Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study.
abstract: BACKGROUND
  Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits.
  
  
  RESULTS
  This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; P=0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; P<0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (P<0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (P=0.026).
  
  
  CONCLUSIONS
  Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873899.
authors.affiliation: Dipartimento di Cardiologia, Fondazione IRCCS Policlinico San Matteo, P. le Golgi 2, 27100, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Perego
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guenzati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vicentini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Gabriella
authors.initials: G
authors.lastname: Borghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanaboni
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D019114:Remote Consultation