Impact of a universal monitoring system ("third party") on outcomes of ICD patients: A nationwide study

Background: Adherence to recommended follow-up schedules for remote monitoring (RM) of patients with implantable cardioverter-defibrillators (ICDs) is inconsistent, which may influence clinical outcomes. Systematic organization through a "third-party" universal monitoring system (UMS) may be beneficial.

Objective: We aimed to evaluate the clinical impact of RM and any incremental benefit of UMS vs conventional RM.

Methods: In the comprehensive French nationwide health database, we identified 69,394 ICD patients (67.9 ± 13.4 years; male, 77.5%; 34.9% defibrillator with cardiac resynchronization therapy) with clinical data. Hospitalizations and survival were assessed for 1 year (2019). Patients were classified by RM status (no-RM and RM), then RM separated further by follow-up method (conventional manufacturer-specific RM or UMS). Adjusted annual mortality rates and hospitalizations (all-cause, heart failure, number, and duration) were compared in no-RM vs RM, then conventional RM vs UMS.

Results: Mortality rate was reduced in RM vs no-RM (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.95-0.97; P < .001). In RM, all-cause hospitalizations increased in number but their cumulative duration diminished (HR, 0.98; 95% CI, 0.98-0.99; P < .001). Compared with conventional RM, UMS was associated with reduced rates of mortality (HR, 0.74; 95% CI, 0.73-0.77; P < .001), all-cause and heart failure hospitalizations (HR, 0.96; 95% CI, 0.95-0.97; P < .001), and hospital stay duration (HR, 0.96; 95% CI, 0.95-0.97; P < .001).

Conclusion: RM was associated with improved survival in ICD recipients. Importantly, we found that use of UMS was associated with additional improvement in clinical outcomes, including survival and hospitalizations. These observations point to organizational challenges in conventionally managed RM that can be mitigated by a universal monitoring platform.