Compliance with remote monitoring of ICDS/CRTDS in a real-world population.
BACKGROUND
Remote monitoring (RM) of defibrillators (implantable cardioverter defibrillators [ICDs]) and cardiac resynchronization therapy devices (CRTDs) has been shown to be cost effective, convenient, and associated with reduced mortality and a reduction in the time to physician intervention for actionable events. However, patient compliance with monitoring over time and what factors might influence such compliance have not been well described. This study sought to identify factors contributing to patient noncompliance with RM of ICDs and CRTDs in a large real-world population.


METHODS
Deidentified data on U.S. patients enrolled in the Medtronic CareLink RM system were used to compare patients with no (noncompliant, n = 14,848) and with ≥ 2 RM transmissions (compliant, n = 103,284) during a 14-month period.


RESULTS
Overall noncompliance with RM was 21%. Younger age (≤ 40), female sex, wanded device, Medicare Census Division, and small clinic size all predicted patient noncompliance (P < 0.01). Device type (ICD vs CRTD) did not (P = 0.52). Multivariate analysis suggested clinically important predictors of noncompliance to be: age ≤ 40, odds ratio (OR) 2.64 (95% confidence interval, 2.42-2.88); Medicare Census Division (Mountain vs West North Central), OR 2.15 (1.96-2.37); and small clinic size (1-4 vs >100 patients), OR 4.38 (3.92-4.91).


CONCLUSIONS
There is room for improvement in RM usage among enrolled patients. Younger patients, smaller clinics, and certain geographic areas may be targets for research into interventions to further improve the use of RM.
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
Lynda E
LE
Rosenfeld
Amisha S
AS
Patel
Vivek B
VB
Ajmani
Reece W
RW
Holbrook
Trina A
TA
Brand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D058998:Remote Sensing Technology; D012189:Retrospective Studies
cardiac resynchronization therapy devices; implantable cardioverter defibrillators; patient compliance; remote monitoring