Digital Health -> Digital Health D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-070 - Remote Monitoring Of Implantable Cardioverter Defibrillators: A Systematic Review And Meta-analysis (ID 72)

Abstract

Background: Remote monitoring (RM) is guideline-recommended for the follow-up of implantable cardioverter defibrillators (ICDs). Previous studies suggest an RM-associated mortality benefit in ICD patients, as well as superior outcomes with daily device downloads.
Objective: To conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing RM and usual care (UC) in patients with an ICD +/- cardiac resynchronisation therapy (CRT).
Methods: We undertook a database search of PubMed and Embase. We included RCTs comparing RM versus UC in ICD patients, reporting on any of the following outcomes: All-cause mortality, cardiovascular mortality, shocks, inappropriate shocks, and cardiovascular/heart failure/ICD-related hospitalisation.
Results: 13 RCTs were identified and included in the final analysis, including 6778 patients, 3655 who received RM and 3123 who received UC. There were no significant between-group differences in all-cause mortality (odds ratio [OR] 0.91, p=0.69) (Figure 1), cardiovascular mortality (OR 0.8, p=0.32) or cardiovascular/heart failure/ICD-related hospitalisation (OR 0.81, p=0.14). Sub-group analysis of 6 RCTs using an RM system involving daily device downloads also demonstrated no mortality benefit with RM (OR 0.79, p=0.26). The single study (IN-TIME) demonstrating an RM-associated mortality benefit employed a uniquely managed clinical response pathway to RM alerts, with third-party alert adjudication and aggressive measures to maximise patient compliance with RM. Patients receiving RM were significantly less likely to receive an inappropriate shock (OR 0.51, p=0.02); however, there was no significant difference in the risk of receiving any ICD shock (OR 0.82, p=0.26).
Conclusion: In this systematic review and meta-analysis of 13 RCTs, RM significantly reduced the odds of receiving an inappropriate shock. Individual RCTs demonstrated variable mortality and hospitalisation results; however, overall, RM was not associated with a significant reduction in death, cardiovascular death, or cardiovascular/heart failure/ICD-related hospitalisation. Further clinical trials evaluating various RM delivery modes are required to establish mechanisms to maximise optimal outcomes with RM.
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