title: Remote monitoring of patients with implantable cardioverter-defibrillators: can results from large clinical trials be transposed to clinical practice?
abstract: BACKGROUND
  Remote monitoring (RM) is increasingly used to follow up patients with implantable cardioverter-defibrillators (ICDs). Randomized control trials provide evidence for the benefit of this intervention, but data for RM in daily clinical practice with multiple-brands and unselected patients is lacking.
  
  
  OBJECTIVE
  To assess the effect of RM on patient management and clinical outcome for recipients of ICDs in daily practice.
  
  
  METHODS
  We reviewed ICD recipients followed up at our institution in 2009 with RM or with traditional hospital only (HO) follow-up. We looked at the effect of RM on the number of scheduled ambulatory follow-ups and urgent unscheduled consultations, the time between onset of asymptomatic events to clinical intervention and the clinical effectiveness of all consultations. We also evaluated the proportion of RM notifications representing clinically relevant situations.
  
  
  RESULTS
  We included 355 patients retrospectively (RM: n=144, HO: n=211, 76.9% male, 60.3±15.2 years old, 50.1% with ICDs for primary prevention and mean left ventricular ejection fraction 35.5±14.5%). Average follow-up was 13.5 months. The RM group required less scheduled ambulatory follow-up consultations (1.8 vs. 2.1/patient/year; P<0.0001) and a far lower median time between the onset of asymptomatic events and clinical intervention (7 vs. 76 days; P=0.016). Of the 784 scheduled ambulatory follow-up consultations carried out, only 152 (19.4%) resulted in therapeutic intervention or ICD reprogramming. We also found that the vast majority of RM notifications (61.9%) were of no clinical relevance.
  
  
  CONCLUSIONS
  RM allows early management of asymptomatic events and a reduction in scheduled ambulatory follow-up consultations in daily clinical practice, without compromising safety, endorsing RM as the new standard of care for ICD recipients.
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Morichau-Beauchant
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France. Electronic address: stephane.boule@chru-lille.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Finat
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Botcherby
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, Paris Descartes University, Sorbonne Paris Cité, 75015 Paris, France.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Périer
authors.affiliation: Lille University Hospital, Biostatistics Unit, 59037 Lille, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.affiliation: Inserm U970, Paris Cardiovascular Research Centre, Paris Descartes University, Sorbonne Paris Cité, 75015 Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Guibout
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France; University of Lille 2, Faculty of Medicine, 59045 Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France; University of Lille 2, Faculty of Medicine, 59045 Lille, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Wissocque
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France; University of Lille 2, Faculty of Medicine, 59045 Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Lille University Hospital, Department of Cardiovascular Medicine, 59037 Lille, France; University of Lille 2, Faculty of Medicine, 59045 Lille, France.
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D013318:Stroke Volume; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Defibrillators; Défibrillateur automatique implantable; Follow-up; Implantable cardioverter-defibrillator; Remote monitoring; Suivi; Telemedicine; Télécardiologie; Télésurveillance