title: Influence of remote monitoring on long-term cardiovascular outcomes after cardioverter-defibrillator implantation.
abstract: OBJECTIVE
  Device-based remote monitoring (RM) has been linked to improved clinical outcomes at short to medium-term follow-up. Whether this benefit extends to long-term follow-up is unknown. We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICD).
  
  
  METHODS
  We performed a retrospective cohort study of consecutive patients who underwent ICD implantation for primary prevention. RM was initiated with patient consent according to availability of RM hardware at implantation. Patients with concomitant cardiac resynchronization therapy were excluded. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. A Cox proportional hazards model was employed to estimate the effect of RM on mortality and a composite endpoint of cardiovascular mortality and hospital admission due to heart failure (HF).
  
  
  RESULTS
  312 patients were included with a median follow-up of 37.7months (range 1 to 146). 121 patients (38.2%) were under RM since the first outpatient visit post-ICD and 191 were in conventional follow-up. No differences were found regarding age, left ventricular ejection fraction, heart failure etiology or NYHA class at implantation. Patients under RM had higher long-term survival (hazard ratio [HR] 0.50, CI 0.27-0.93, p=0.029) and lower incidence of the composite outcome (HR 0.47, CI 0.27-0.82, p=0.008). After multivariate survival analysis, overall survival was independently associated with younger age, higher LVEF, NYHA class lower than 3 and RM.
  
  
  CONCLUSIONS
  RM was independently associated with increased long-term survival and a lower incidence of a composite endpoint of hospitalization for HF or cardiovascular mortality.
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal. Electronic address: Gfportugal@gmail.com.
authors: Guilherme
authors: G
authors: Portugal
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Pedro
authors: P
authors: Cunha
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Bruno
authors: B
authors: Valente
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Joana
authors: J
authors: Feliciano
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Ana
authors: A
authors: Lousinha
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Sandra
authors: S
authors: Alves
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Manuel
authors: M
authors: Braz
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Ricardo
authors: R
authors: Pimenta
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Ana Sofia
authors: AS
authors: Delgado
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Mário
authors: M
authors: Oliveira
authors: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal.
authors: Rui C
authors: RC
authors: Ferreira
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: ICD; Remote monitoring