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Efficacy of ICD/CRT-D Remote Monitoring in Patients With HFrEF: a Bayesian Meta-analysis of Randomized Controlled
Ahmad Al-Abdouh1, Mohammed Mhanna2, Mohammad As Sayaideh3
1Division of Hospital Medicine, University of Kentucky, Lexington, KY, 40536, USA. ahmad_alabdouh@yahoo.com.
Insights
Remote monitoring with implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices may reduce mortality in heart failure (HF) patients. This approach shows a higher probability of reduced all-cause and cardiovascular mortality compared to standard care alone.
Area of Science:
- Cardiology
- Medical Technology
- Health Informatics
Background:
- Heart failure (HF) is a significant cause of morbidity and mortality worldwide.
- Traditional HF management relies on in-person visits and standard device follow-up.
- Remote monitoring technologies offer potential for enhanced patient care and outcomes.
Purpose of the Study:
- To evaluate the efficacy of remote monitoring using implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices.
- To assess remote monitoring as an adjunctive tool to traditional care for HF patients.
Main Methods:
- A systematic review and meta-analysis of 11 randomized controlled trials.
- Inclusion of 5965 patients diagnosed with heart failure.
- Bayesian hierarchical methods were used to compute pooled risk differences.
Main Results:
- Remote monitoring with ICD/CRT-D devices was associated with a reduced absolute risk difference (ARD) for all-cause mortality (centered at -0.01).
- A reduced ARD was also observed for cardiovascular mortality (centered at -0.03).
- There is an 82% probability of reduced all-cause mortality and an 84% probability of reduced cardiovascular mortality with remote monitoring compared to standard care.
Conclusions:
- Remote monitoring using ICD/CRT-D devices is associated with a higher probability of reduced all-cause and cardiovascular mortality in HF patients.
- This technology serves as a valuable adjunctive tool to standard HF care.
- Further research may explore long-term benefits and cost-effectiveness.
Purpose Of Review:
To evaluate remote monitoring using implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices as an adjunctive tool to the traditional care of patients with heart failure (HF).
Recent Findings:
We included 11 trials encompassing 5965 patients. Absolute risk difference (ARD) with 95% credible interval (CrI) was estimated. Pooled (posterior) risk difference was computed using Bayesian hierarchical methods. The ARD for mortality was centered at - 0.01 (95% CrI: - 0.03; 0.01, Tau: 0.02), with an 82% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for cardiovascular mortality was centered at - 0.03 (95% CrI: - 0.11; 0.05, Tau: 0.10), with an 84% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. ICD/CRT-D remote monitoring in patients with HF is associated with a higher probability of reduced all-cause and cardiovascular mortality compared with standard care alone.
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