Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A...

Area of Science:

• Cardiology
• Health Economics
• Health Services Research

Background:

• Expert recommendations support remote monitoring (RM) for cardiac implantable electronic devices (CIEDs).
• Clinical implementation of RM remains limited due to funding inconsistencies and uncertainty about its impact on cardiovascular outcomes.
• Need for real-world evidence on RM's effectiveness and cost-efficiency.

Purpose of the Study:

• To evaluate the association of remote monitoring (RM) with mortality and cardiovascular hospitalizations in patients with de novo implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy with defibrillator (CRT-D) devices.
• To assess the direct health costs and economic benefits of RM compared to standard in-clinic follow-up.
• To construct a decision-analytic model for long-term cost-effectiveness projections.

Main Methods:

• Population-based cohort study using administrative health data from Alberta, Canada (2010-2016).
• Analysis of 2799 patients with de novo ICD or CRT-D devices, assessing RM status.
• Cox proportional hazards models for mortality/hospitalization; generalized linear models for costs; Markov model for economic projections.

Main Results:

• Remote monitoring (RM) was used in 63.4% of patients (n=1830) with a mean follow-up of 50.3 months.
• Adjusted analysis showed RM significantly reduced the risk of all-cause mortality (HR 0.43) and cardiovascular hospitalization (HR 0.76).
• Economic modeling projected 5-year cost savings of $12,195 per person with RM, observed in 99% of simulations.

Conclusions:

• Real-world data demonstrate that remote monitoring (RM) for CIEDs is associated with improved patient outcomes, including reduced mortality and hospitalizations.
• RM technology presents a cost-effective strategy, generating significant savings for the health system.
• Widespread implementation of RM is supported to enhance patient care and health system efficiency.