title: A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort.
abstract: OBJECTIVE
  There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs).
  
  
  METHODS
  We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death.
  
  
  RESULTS
  Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS).
  
  
  CONCLUSIONS
  In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death.
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal. Electronic address: gfportugal@gmail.com.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Portugal
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cunha
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Valente
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Feliciano
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Lousinha
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Sandra
authors.initials: S
authors.lastname: Alves
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Braz
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pimenta
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisbon, Portugal.
authors.forename: Rui C
authors.initials: RC
authors.lastname: Ferreira
mesh_terms: D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D057216:Propensity Score; D058996:Quality Improvement; D058998:Remote Sensing Technology; D012189:Retrospective Studies; D013997:Time Factors
keywords: Cardioversor-desfibrilhador implantável; Heart failure; Implantable cardioverter-defibrillator; Insuficiência cardíaca; Monitorização remota; Remote monitoring