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Remote management of heart failure using implantable electronic devices

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journal contribution
posted on 15.08.2017, 09:31 by John M. Morgan, Sue Kitt, Jas Gill, Janet M. McComb, Ghulam Andre Ng, James Raftery, Paul Roderick, Alison Seed, Simon G. Williams, Klaus K. Witte, David Jay Wright, Scott Harris, Martin R. Cowie
Aims: Remote management of heart failure using implantable electronic devices (REM-HF) aimed to assess the clinical and cost-effectiveness of remote monitoring (RM) of heart failure in patients with cardiac implanted electronic devices (CIEDs). Methods and results: Between 29 September 2011 and 31 March 2014, we randomly assigned 1650 patients with heart failure and a CIED to active RM or usual care (UC). The active RM pathway included formalized remote follow-up protocols, and UC was standard practice in nine recruiting centres in England. The primary endpoint in the time to event analysis was the 1st event of death from any cause or unplanned hospitalization for cardiovascular reasons. Secondary endpoints included death from any cause, death from cardiovascular reasons, death from cardiovascular reasons and unplanned cardiovascular hospitalization, unplanned cardiovascular hospitalization, and unplanned hospitalization. REM-HF is registered with ISRCTN (96536028). The mean age of the population was 70 years (range 23–98); 86% were male. Patients were followed for a median of 2.8 years (range 0–4.3 years) completing on 31 January 2016. Patient adherence was high with a drop out of 4.3% over the course of the study. The incidence of the primary endpoint did not differ significantly between active RM and UC groups, which occurred in 42.4 and 40.8% of patients, respectively [hazard ratio 1.01; 95% confidence interval (CI) 0.87–1.18; P = 0.87]. There were no significant differences between the two groups with respect to any of the secondary endpoints or the time to the primary endpoint components. Conclusion: Among patients with heart failure and a CIED, RM using weekly downloads and a formalized follow up approach does not improve outcomes.

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Citation

European Heart Journal, 2017, 38 (30), pp. 2352-2360

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

European Heart Journal

Publisher

Oxford University Press (OUP)

issn

0195-668X

eissn

1522-9645

Acceptance date

11/04/2017

Copyright date

2017

Available date

15/08/2017

Publisher version

https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehx227

Language

en

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