Impact of Remote Monitoring on Long-Term Prognosis in Heart Failure Patients in a Real-World Cohort: Results From All-Comers COMMIT-HF Trial.
BACKGROUND
Randomized controlled trials demonstrate that remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT-Ds) may improve quality of care and prognosis in heart failure (HF) patients. However, the impact of RM on long-term mortality in a real-world cohort is still not well examined.


RESULTS
This study was designed as a matched cohort study based on the COMMIT-HF trial--a single-center, ongoing prospective observational registry (NCT02536443). Complete patient demographics, medical history, in-hospital results, hospitalizations, and mortality data were collected based on institutional registries and healthcare providers' records. Patients were divided into 2 groups based on RM presence and matched by means of propensity scores according to clinical characteristics. The primary endpoint of this study was the long-term all-cause mortality. Out of 1,429 consecutive patients, 822 patients with a first implantation of an ICD/CRT-D were included in the analysis. The final matched study population contained 574 patients in RM and in a control group. Although demographic and echocardiographic parameters as well as pharmacological treatments were similar in both groups, a significantly lower 1-year mortality was detected in the RM group (2.1% vs. 11.5%, P < 0.0001). This was also maintained during a 3-year follow-up (4.9% vs. 22.3%, P < 0.0001). Multivariate analysis showed that RM was associated with an improved prognosis (hazard ratio 0.187, 95% confidence interval 0.075-0.467, P = 0.0003).


CONCLUSIONS
RM of HF patients with ICDs/CRT-Ds significantly reduced long-term mortality in a real-world clinical condition.
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Anna
A
Kurek
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Mateusz
M
Tajstra
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Elzbieta
E
Gadula-Gacek
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Piotr
P
Buchta
Department of Biostatistics, Medical University of Silesia, Bytom, Poland.|Department of Science, Training and New Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
Michal
M
Skrzypek
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Lukasz
L
Pyka
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Michal
M
Wasiak
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Malgorzata
M
Swietlinska
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Michal
M
Hawranek
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Lech
L
Polonski
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Mariusz
M
Gasior
Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
Jedrzej
J
Kosiuk
D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry; D013997:Time Factors
heart failure; implantable cardioverter-defibrillators; mortality; outcome; remote monitoring