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Impact of remote monitoring on clinical outcomes for patients with heart failure and atrial fibrillation: results from the REM-HF trial

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journal contribution
posted on 2020-04-02, 09:36 authored by Rosita Zakeri, John M Morgan, Patrick Phillips, Sue Kitt, G Andre Ng, Janet M McComb, Simon Williams, David J Wright, Jaswinder S Gill, Alison Seed, Klaus K Witte, Martin R Cowie
Aims: Studies of remote monitoring (RM) in heart failure (HF) speculate that patients with atrial fibrillation (AF) derive the greatest benefit. We compared the impact of RM vs. usual care on clinical outcomes for patients with and without AF enrolled in the Remote Management of Heart Failure Using Implanted Electronic Devices (REM-HF) trial. Methods and results: Rhythm status was available for 1561 patients (94.6%). Three categories were defined based on total AF duration during the first year of follow-up: (i) no AF (n = 1211, 77.6%), (ii) paroxysmal AF (≥6 min to ≤7 days; n = 92, 5.9%), and (iii) persistent/permanent AF (>7 days; n = 258, 16.5%). Clinical activity, mortality, and hospitalisation rates were compared between treatment strategies for each group. RM resulted in a greater volume of clinical activity in patients with any AF, vs. no AF, with the highest per-patient intervention required for patients with persistent/permanent AF. During 2.8 ± 0.8 years of follow-up, RM was not associated with a reduction in all-cause or cardiovascular mortality for patients with AF. However, in patients with persistent/permanent AF, RM conferred an increased risk of recurrent cardiovascular [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.06–1.85, P = 0.018] and HF-related (HR 2.05, 95% CI 1.14–3.69, P = 0.016) hospitalisations. Conclusion: In patients with HF and a cardiac implanted electronic device, RM generated greater clinical activity for patients with AF, with no associated reduction in mortality, and conversely, greater risk of cardiovascular hospitalisation amongst patients with persistent/permanent AF. RM strategies may vary in their capability to guide HF management; modified approaches may be needed to improve outcomes for HF patients with AF.

Funding

This work was supported by the British Heart Foundation (grant 28479) and Boston Scientific Ltd (Arden Hills, St Paul, MN, USA), Medtronic Ltd, (Minneapolis, MN, USA), and St Jude Medical, (Minneapolis, MN, USA).

History

Citation

European Journal of Heart Failure, 2020, Vol 22, Issue 3, pp. 543-553

Author affiliation

Leicester Biomedical Research Centre

Version

  • AM (Accepted Manuscript)

Published in

European Journal of Heart Failure

Volume

22

Issue

4

Pagination

543-553

Publisher

Wiley for European Society of Cardiology

issn

1388-9842

eissn

1879-0844

Acceptance date

2019-11-13

Copyright date

2020

Publisher version

https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1709

Spatial coverage

England

Language

English