Abstract 13944: Early Initiation of Remote Monitoring in CIED Patients is Associated with Reduced Mortality
Introduction: Remote monitoring (RM) of cardiac implantable electronic devices (CIED) has been associated with reduced mortality. However, the relationship between the time from device implantation to initiation of RM and survival is unknown.
Hypothesis: Following CIED implantation, early (within 91 days) initiation of remote monitoring will result in improved survival as compared to later initiation.
Methods: Patients implanted with a St. Jude Medical™ CIED (2008-2011) that participated in RM were included and data collected through Nov 2012. Patients enrolled in a clinical study were excluded. Age, gender, device type, and surveillance duration were ascertained using device tracking data. Weekly RM service utilization was determined from Merlin.net™. The index time was set as the time of first RM transmission (RM1). The all-cause mortality incidence rate (MIR) was evaluated for each device type among patients with early (≤ 91 days) or late (> 91 days, ≤ 52 weeks) time from device implant to RM1. All-cause survival was prospectively compared for each device type among patients with early or late time to RM1 using Cox proportional hazards with gender as a covariate and stratification on age.
Results: We evaluated 105,285 RM patients (71 ± 13 years, 64% male) with a PM (n= 46,758, 44%), ICD (n= 31,697, 30%), or CRT device (n= 26,830, 26%). The median time to RM1 was 8 [4, 19] weeks. In comparison to patients with late RM1 (median: 24 weeks), patients with early RM1 (median 4 weeks) had lower MIR (4,114 vs 4,924 per 100k-pt-yrs, p< 0.001) and greater survival (adjusted HR: 1.27 [CI: 1.22-1.32], p< 0.001). This relationship held across each of the device types (Table.)
Conclusion: Our data show that survival is higher in patients who have a shorter time between device implant and remote monitoring initiation, across all CIED device types. These data suggest RM should be initiated as soon as possible following device implantation.
Author Disclosures: S. Mittal: Consultant/Advisory Board; Modest; St Jude Medical. J. Piccini: Research Grant; Significant; Boston Scientific, Corp.. Consultant/Advisory Board; Modest; Medtronic, Inc. F. Avi: Employment; Significant; St. Jude Medical, Inc. J. Snell: Employment; Significant; St. Jude Medical, Inc. N. Dalal: Employment; Significant; St. Jude Medical, Inc. N. Varma: Consultant/Advisory Board; Modest; St. Jude Medical, Inc..
- © 2014 by American Heart Association, Inc.