title: Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation.
abstract: OBJECTIVE
  Guidelines advocate remote monitoring (RM) in patients with a cardiac implantable electronic device (CIED). However, it is not known when RM should be initiated. We hypothesized that prompt initiation of RM (within 91 days of implant) is associated with improved survival compared to delayed initiation.
  
  
  METHODS
  This retrospective, national, observational cohort study evaluated patients receiving new implants of market-released St. Jude Medical™ pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices. Patients were assigned to one of two groups: an "RM Prompt" group, in which RM was initiated within 91 days of implant; and an "RM Delayed" group, in which RM was initiated >91 days but ≤365 days of implant. The primary endpoint was all-cause mortality.
  
  
  RESULTS
  The cohort included 106,027 patients followed for a mean of 2.6 ± 0.9 years. Overall, 47,014 (44 %) patients had a PM, 31,889 (30 %) patients had an ICD, 24,005 (23 %) patients had a CRT-D, and 3119 (3 %) patients had a CRT-P. Remote monitoring was initiated promptly (median 4 weeks [IQR 2, 8 weeks]) in 66,070 (62 %) patients; in the other 39,957 (38 %) patients, RM initiation was delayed (median 24 weeks [IQR 18, 34 weeks]). In comparison to delayed initiation, prompt initiation of RM was associated with a lower mortality rate (4023 vs. 4679 per 100,000 patient-years, p < 0.001) and greater adjusted survival (HR 1.18 [95 % CI 1.13-1.22], p < 0.001).
  
  
  CONCLUSIONS
  Our data, for the first time, show improved survival in patients enrolled promptly into RM following CIED implantation. This advantage was observed across all CIED device types.
authors: Valley Health System of New York and New Jersey, 223 North Van Dien Avenue, Ridgewood, NJ, 07450, USA. mittsu@valleyhealth.com.
authors: Suneet
authors: S
authors: Mittal
authors: Duke University Medical Center, Durham, NC, USA.
authors: Jonathan P
authors: JP
authors: Piccini
authors: Data Informs, LLC, Sylmar, CA, USA.
authors: Jeff
authors: J
authors: Snell
authors: St. Jude Medical, Inc., Sylmar, CA, USA.
authors: Julie B
authors: JB
authors: Prillinger
authors: St. Jude Medical, Inc., Sylmar, CA, USA.
authors: Nirav
authors: N
authors: Dalal
authors: Cleveland Clinic, Cleveland, OH, USA.
authors: Niraj
authors: N
authors: Varma
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D018579:Patient Selection; D015995:Prevalence; D058998:Remote Sensing Technology / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017216:Telemedicine / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality
keywords: Cardiac implantable electronic device; Remote monitoring; Survival; Time to enrollment