title: Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators.
abstract: BACKGROUND
  We examined the association between the use of remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICD) and all-cause mortality and rehospitalization among patients undergoing initial ICD implant.
  
  
  RESULTS
  A limited data set was constructed from Boston Scientific ALTITUDE Registry and National Cardiovascular Data Registry ICD Registry between January 2006 and March 2010. Vital status was determined using the Social Security Death Master File. All-cause mortality up to 3 years was compared in patients who used RPM with those who did not use RPM. Time-dependent frailty Cox models quantified the association between RPM use and all-cause mortality. Analyses were repeated in subgroups based on age, sex, race, ICD type, indication, and cardiomyopathy pathogenesis. Similar methodology examined the association between RPM use and all-cause rehospitalization in patients enrolled in Medicare fee-for-service patients ≥65 years. The study cohort (n=37,742, age 67±13, 72% male) had a 3-year mortality of 20.9% (median follow-up 832 days). In multivariable analyses, patients using RPM (n=22,023, 58%) had lower risk of mortality compared with those not using RPM (hazard ratio 0.67, 95% confidence interval 0.64-0.71, P<0.0001). The 3-year all-cause rehospitalization rate in the Medicare population (n=15,254) was 69.3% (median follow-up 922 days). Risk of rehospitalization of patients using RPM (n=9150, 60%) was lower than those not using RPM (hazard ratio 0.82, 95% confidence interval 0.80-0.84, P<0.0001). Findings were consistent across subgroups.
  
  
  CONCLUSIONS
  Among patients undergoing initial ICD implant, RPM use is associated with significantly lower risk of adverse outcomes.
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Akar
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Haikun
authors.initials: H
authors.lastname: Bao
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Stein
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Saxon
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.).
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine & Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (J.G.A., H.B., Y.W., J.P.C.); Clinical Department, Boston Scientific Corporation, St. Paul, MN (P.W.J., K.M.S.); Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.D.V., F.A.M.); Division of Cardiovascular Medicine, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles (L.A.S.); and Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.). jeptha.curtis@yale.edu.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis
keywords: cardiomyopathy; defibrillation; fee-for-service plans; registry; sudden death