Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators: Insights from the Patient RElated Determinants of ICD Remote Monitoring (PREDICt RM) Study
Background—Current guidelines recommend using remote patient monitoring (RPM) for implantable cardioverter-defibrillators (ICD), but the patterns of adoption of this technology have not been described. Successful use of RPM depends on: 1) enrollment of the patient into an RPM system and 2) subsequent activation of RPM by the enrolled patient. We examined RPM enrollment and activation rates and the patient, physician, and institutional determinants of RPM use.
Methods and Results—Information about the use of RPM-capable devices was obtained from the Boston Scientific Corporation (BSC) ALTITUDE program and linked to the NCDR® ICD Registry™. Patients were first categorized as "RPM-enrolled" and "RPM-not enrolled" and the RPM-enrolled patients were further categorized into "RPM-active" and "RPM-inactive" groups based on whether they transmitted RPM data. Variables associated with RPM enrollment and activation were identified using multivariable logistic regression. Among 39,158 patients with newly-implanted RPM-capable devices, 62% (n=24,113) were RPM-enrolled. Of those enrolled, 76% (n=18,289, or 47% of the entire cohort) activated their device. RPM enrollment was highly variable among institutions. The hospital-specific median odds ratio for RPM enrollment was 3.43, signifying that physician/institutional factors are associated with RPM enrollment. In contrast, the hospital-specific median odds ratio for RPM activation was 1.69. Age, race, health insurance, geographic location and health-related factors were similarly associated with both RPM enrollment and activation.
Conclusions—RPM technology is used in less than half of eligible patients. Lack of enrollment into RPM systems is the major cause of under-utilization and this primarily relates to the local practice environment.
- Received March 11, 2013.
- Revision received August 20, 2013.
- Accepted September 3, 2013.