Frequent visitor to our news pages, cardiovascular device specialist Biotronik has announced new trial results indicating that patient adherence to follow-up following Implantable Cardioverter/Defibrillator (ICD) implantation is 25% higher when performed remotely than when it is a traditional, calendar-based, in-person event.
Care of both patient and device after ICD implantation is an essential component in delivering therapy success, appropriate monitoring having been shown to prolong, and enhance quality of life. Follow-up has traditionally been conducted according to fixed, calendar-based, in-person appointments every three or six months. Not for much longer one suspects: Technology has leapt forward in recent years, with the introduction of implantable devices with integrated remote monitoring technology that can automatically transmit medical data as well as technical data about the implant to the physician on a daily basis. This technology helps the physician keep continuous track of a patient’s health status and adapt therapy when necessary in a way that has the potential to outstrip the periodic outpatient visit.
The current guidelines of the European Society of Cardiology (ESC) indicate that a completely automatic and proven remote monitoring system will play an even more important role in the future of device therapy.
As if to reinforce this move, we now have a new dataset that appears to offer further support for the remote monitoring approach. The data comes from from a sub-analysis of the landmark TRUST trial, published in the European Heart Journal.
This analysis looked for differences in patient adherence in two groups, patients who were given remote follow-ups with Biotronik Home Monitoring® and those who had calendar-based, in-person follow-ups.
The prospective, randomized, multi-center TRUST clinical trial enrolled 1,450 patients at 102 North American sites. It has demonstrated the safety and efficacy of Biotronik Home Monitoring® in reducing in-office follow-ups by 45 percent and now, this sub-analysis shows that remote follow-ups with Home Monitoring also improve patient retention. Within the Home Monitoring group, there was an overall 25 percent greater adherence to all recommended follow-up evaluations. There was also higher adherence to the yearly in-person evaluation when compared with conventional patient management, which was twice as likely to lead to a missed follow-up.
Overall then, if improved adherence correlates with improved outcomes, not to mention a reduced requirement for costly and burdensome in-office appointments, it’s not difficult to make a case that technology is genuinely enhancing patient care in a cost-sensitive fashion worthy of these times.
“The TRUST trial demonstrated that automatic remote patient management is more efficient for the clinic. Now, this sub-analysis also shows that Home Monitoring is more effective and reliable in reaching follow-up goals,” explained primary investigator Niraj Varma, MD, Cleveland Clinic, Ohio, US. “More frequent conventional, routine in-person evaluations were shown to lead to patient attrition, as patients were perhaps more likely to drop out of the follow-up process when they viewed multiple follow-ups as unnecessary and intrusive.”
“The TRUST study leads us to believe that we should re-evaluate the traditional standard of care based on in-office evaluation,” added Varma. “Perhaps, instead of in-person follow-ups for post-implant patients, the new standard should be automatic, daily remote monitoring, which may lead to more effective patient treatment”
Full release here