title: The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients.
abstract: BACKGROUND
  Remote monitoring (RM) technology embedded within cardiac rhythm devices permits continuous monitoring, which may result in improved patient outcomes.
  
  
  OBJECTIVE
  This study used "big data" to assess whether RM is associated with improved survival and whether this is influenced by the type of cardiac device and/or its degree of use.
  
  
  METHODS
  We studied 269,471 consecutive U.S. patients implanted between 2008 and 2011 with pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy (CRT) with pacing capability (CRT-P)/defibrillation capability (CRT-D) with wireless RM. We analyzed weekly use and all-cause survival for each device type by the percentage of time in RM (%TRM) stratified by age. Socioeconomic influences on %TRM were assessed using 8 census variables from 2012.
  
  
  RESULTS
  The group had implanted PMs (n = 115,076; 43%), ICDs (n = 85,014; 32%), CRT-D (n = 61,475; 23%), and CRT-P (n = 7,906; 3%). When considered together, 127,706 patients (47%) used RM, of whom 67,920 (53%) had ≥75%TRM (high %TRM) and 59,786 (47%) <75%TRM (low %TRM); 141,765 (53%) never used RM (RM None). RM use was not affected by age or sex, but demonstrated wide geographic and socioeconomic variability. Survival was better in high %TRM versus RM None (hazard ratio [HR]: 2.10; p < 0.001), in high %TRM versus low %TRM (HR: 1.32; p < 0.001), and also in low %TRM versus RM None (HR: 1.58; p < 0.001). The same relationship was observed when assessed by individual device type.
  
  
  CONCLUSIONS
  RM is associated with improved survival, irrespective of device type (including PMs), but demonstrates a graded relationship with the level of adherence. The results support the increased application of RM to improve patient outcomes.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: varman@ccf.org.
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Duke University, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Scientific Division, St. Jude Medical, Inc., Sylmar, California.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Snell
authors.affiliation: Scientific Division, St. Jude Medical, Inc., Sylmar, California.
authors.forename: Avi
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Scientific Division, St. Jude Medical, Inc., Sylmar, California.
authors.forename: Nirav
authors.initials: N
authors.lastname: Dalal
authors.affiliation: Department of Electrophysiology, Valley Health System, New York, New York and Ridgewood, New Jersey.
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010349:Patient Compliance; D058998:Remote Sensing Technology / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: big data; cardiac electronic implantable devices; cardiac resynchronization therapy; device; mortality; survival; time in remote monitoring