57 * Remote monitoring of permanent pacemakers is associated with reduced mortality

Abstract

Introduction: Remote monitoring (RM) is associated with reduced mortality in cardiac resynchronisation therapy-defibrillator (CRT-D) patients and implantable cardioverter defibrillator (ICD) patients. We sought to determine whether this benefit extends to pacemaker patients. Methods: All patients that were implanted with a pacemaker between November 2010 and November 2011 at The Wiltshire Cardiac Centre were included. Age, gender, device manufacturer, number of follow-up appointments (including clinical, routine remote and remote alarm events), time to detection of clinically important arrhythmia (new atrial fibrillation or non-sustained ventricular tachycardia), unscheduled hospitalisation (Cardiac and non-cardiac) and allcause mortality were ascertained from electronic patient records. RM patients were compared to patients under conventional clinical follow-up using an intention to treat analysis. Unpaired Student's t-test was used to determine statistical significance. Results: We analysed 189 consecutive patients who were implanted with a pacemaker at The Wiltshire Cardiac Centre between November 2010 and November 2011 (6 patients were excluded; 4 moved out of area and were lost to follow-up, 2 were upgraded to CRT). 137 Clinical and 46 RM patients were identified. RM patients were significantly younger (74.4+/-13.9 years vs 79.5+/-10.9, P = 0.012), received a significantly greater number of follow-up events (8.2+/-3.1 vs 5.1+/-2.4, P < 0.001), had arrhythmia identified significantly more quickly (2.09 days+/-1.41 vs 165+/-145, p < 0.001), had significantly fewer non-cardiac hospitalisations (0.48+/-0.91 vs 1.09+/-1.48, P = 0.009) and significantly reduced all-cause mortality (0.07+/-0.25 vs 0.32+/-0.47, P = 0.007) compared to patients under clinical followup. Unscheduled cardiac hospitalisation (Refractory angina, Non-fatal MI, Cardiac Failure) rates were similar between groups (0.10+/-0.43 vs 0.10+/-0.32, P = 0.92). Conclusions: RM was associated with significantly reduced all-cause mortality compared to clinical follow-up. Rapid detection of arrhythmia, greater number of follow-up events, fewer unscheduled non-cardiac hospitalisations and younger age group may have been contributing factors. Unscheduled cardiac hospitalisations did not appear to contribute. The results ought to be considered hypothesis-generating and large-scale randomised data is required to validate these findings.