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https://hdl.handle.net/2440/99667
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Type: | Journal article |
Title: | Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes |
Author: | Parthiban, N. Esterman, A. Mahajan, R. Twomey, D. Pathak, R. Lau, D. Roberts-Thomson, K. Young, G. Sanders, P. Ganesan, A. |
Citation: | Journal of the American College of Cardiology, 2015; 65(24):2591-2600 |
Publisher: | Elsevier |
Issue Date: | 2015 |
ISSN: | 0735-1097 1558-3597 |
Statement of Responsibility: | Nirmalatiban Parthiban, Adrian Esterman, Rajiv Mahajan, Darragh J. Twomey, Rajeev K. Pathak, Dennis H. Lau, Kurt C. Roberts-Thomson, Glenn D. Young, Prashanthan Sanders, Anand N. Ganesan |
Abstract: | BACKGROUND: Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. OBJECTIVES: This study sought to conduct a systematic literature review and meta-analysis of RCTs comparing RM with IO follow-up. METHODS: Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. RESULTS: In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). CONCLUSIONS: Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks. |
Keywords: | home monitoring mortality shock sudden cardiac death |
Rights: | © 2015 by the American College of Cardiology Foundation. |
DOI: | 10.1016/j.jacc.2015.04.029 |
Published version: | http://dx.doi.org/10.1016/j.jacc.2015.04.029 |
Appears in Collections: | Aurora harvest 7 Medicine publications |
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