title: Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study.
abstract: BACKGROUND
  A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months.
  
  
  METHODS
  Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients.
  
  
  RESULTS
  The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM (p = 0.003) and the achievement of the effective dose of beta-blockers (p = 0.006) were independently and positively associated with an improved outcome.
  
  
  CONCLUSIONS
  In a 'real-world' setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.
authors.affiliation: Ospedale Monaldi, Naples, Italy donofrioant@iol.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Clinica Mediterranea, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.affiliation: Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.affiliation: Ospedale di Ciriè, Ciriè, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Amellone
authors.affiliation: Clinica San Michele, Maddaloni, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Simone
authors.affiliation: Policlinico Universitario, Padua, Italy.
authors.forename: Loira
authors.initials: L
authors.lastname: Leoni
authors.affiliation: Ospedale Civile Maggiore di Borgo Trento, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morani
authors.affiliation: Ospedale Monaldi, Naples, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Boston Scientific Italia, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Campari
authors.affiliation: Boston Scientific Italia, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: Policlinico Universitario, Padua, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Buja
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000077261:Carvedilol; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D018670:Monitoring, Ambulatory / Q000379:methods*; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D017216:Telemedicine; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D017298:Bisoprolol
keywords: Implantable cardioverter defibrillator; cardiac resynchronization therapy; heart failure; remote monitoring; telemedicine