title: Effectiveness of a management program for outpatient clinic or remote titration of beta-blockers in CRT patients: The RESTORE study.
abstract: BACKGROUND
  Many patients fail to receive β-blockers before cardiac resynchronization therapy defibrillator (CRT-D) implantation, or receive them at a suboptimal dose, and require optimization after implantation. We assessed the effectiveness of a structured program for β-blocker titration in CRT-D patients followed up by means of conventional in-clinic visits or remote monitoring.
  
  
  RESULTS
  130 patients undergoing CRT implantation and treated according to the standard practice of the centers were included as a control group. A second group of 124 CRT-D candidates (Study Group) underwent up-titration visits every 2weeks after implantation (target dose: 10mg/day of bisoprolol or 50mg/day of carvedilol). In the Study Group, remote monitoring was undertaken in 66 patients, who received additional equipment for daily transmission of weight and blood pressure data, and scheduled titration telephone calls. In the Control Group, the maximal dose of β-blockers was being administered to 12 (9%) patients on implantation and 21 (16%) on 6-month follow-up examination (p>0.05). In the Study Group, 25 (20%) patients were receiving the maximal dose of β-blockers on implantation and 72 (58%) on follow-up examination (p<0.001). The 66 Study Group patients on remote monitoring underwent fewer in-clinic visits (p=0.034). Of these, 50 (76%) were on the maximal dose after remote up-titration (versus 38% of patients followed up conventionally, p<0.001). The decrease in left ventricular end-systolic volume was larger in the Study Group (p=0.040).
  
  
  CONCLUSIONS
  The program for β-blocker up-titration increased the number of patients reaching the target dose and improved the response to the therapy. The use of remote monitoring and daily transfer of weight and blood pressure data facilitated β-blocker titration.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov/ Identifier: NCT02173028.
authors.affiliation: Ospedale Monaldi, Naples, Italy. Electronic address: donofrioant@iol.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: G. Panico Hospital, Tricase, LE, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Palmisano
authors.affiliation: Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.affiliation: Second University of Naples, A.O. Monaldi, Naples, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ammendola
authors.affiliation: Policlinico Casilino, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.affiliation: Cardarelli Hospital, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ruocco
authors.affiliation: Ospedale Monaldi, Naples, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Federico II University, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Maresca
authors.affiliation: Second University of Naples, A.O. Monaldi, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Del Giorno
authors.affiliation: Policlinico Casilino, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Martino
authors.affiliation: Cardarelli Hospital, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mauro
authors.affiliation: Boston Scientific, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Campari
authors.affiliation: Boston Scientific, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: G. Panico Hospital, Tricase, LE, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Accogli
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000554:Ambulatory Care Facilities; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016022:Case-Control Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058998:Remote Sensing Technology / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: CRT; Heart failure; ICD; Remote monitoring; Telemedicine