Clinical Research Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis
Clinical Research Clinical and Economic Outcomes Associated With Remote Monitoring for Cardiac Implantable Electronic Devices: A Population-Based Analysis
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DOI：
10.1016/j.cjca.2022.01.022
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发表时间：
2022-05-26
影响因子：
6.2
通讯作者：
Wilton, Stephen B.
中科院分区：
文献类型：
--
作者：
Chew, Derek S.;Zarrabi, Mahmood;Wilton, Stephen B.
背景资料：尽管专家建议提倡使用心脏植入式电子设备的远程监测（RM），但由于卫生系统的资助政策不一致以及RM减少不良心血管结局的疗效不确定，常规临床实践中的实施仍然有限。我们对初次植入心脏复律器（ICD）的患者进行了一项基于人群的队列研究使用加拿大阿尔伯塔2010年至2016年的行政健康数据，进行或不进行心脏起搏治疗（CRT-D）。我们使用考克斯比例风险模型评估RM状态作为全因死亡率和心血管（CV）住院的预测因子，并使用广义线性模型评估直接健康成本。从这个现实世界的数据，然后，我们构建了一个决策分析马尔可夫模型来估计预计的成本和效益与RM相比，在诊所访问后续单独的。结果：在2799 ICD和CRT-D患者，1830（63.4%），随后RM平均随访50.3个月。校正年龄、性别和合并症后，RM与较低的死亡风险（风险比[HR] 0.43，95%置信区间[CI] 0.36-0.52; P < 0.001）和CV住院风险（HR 0.76，95% CI 0.64-0.91; P = 0.002）相关。在经济模型中，在5年内观察到成本节约，估计每人节省12，195美元（95% CI -21，818美元至-4，790美元）。该模型估计与RM策略在99%的simulation.Conclusions成本节约：这些人口数据支持更广泛的实施RM技术，以促进更好的患者治疗效果，提高卫生系统的效率。
Background: Despite expert recommendations advocating use of remote monitoring (RM) of cardiac implantable electronic devices, implementation in routine clinical practice remains modest due to inconsistent funding policies across health systems and uncertainty regarding the efficacy of RM to reduce adverse cardiovascular outcomes.Methods: We conducted a population-based cohort study of patients with de novo implantable cardioverter-defibrillators (ICDs) with or without cardiac resynchronization therapy (CRT-D), using administrative health data in Alberta, Canada, from 2010 to 2016. We assessed RM status as a predictor of all-cause mortality and cardiovascular (CV) hospitalization using Cox proportional hazards modelling, and direct health costs by generalized linear models. From this real-world data, we then constructed a decision-analytic Markov model to estimate the projected costs and benefits associated with RM compared with in clinic visit follow-up alone.Results: Among 2799 ICD and CRT-D patients, 1830 (63.4%) were followed by RM for a mean follow-up of 50.3 months. After adjustment for age, sex, and comorbidities, RM was associated with a lower risk of death (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.36-0.52; P < 0.001) and CV hospitalization (HR 0.76, 95% CI 0.64-0.91; P = 0.002). In the economic model, cost savings were observed over 5 years with an estimated savings of $12,195 per person (95% CI -$21,818 to -$4,790). The model estimated a cost-savings associated with RM strategy in 99% of simulations.Conclusions: These population data support more widespread implementation of RM technology to facilitate better patient outcomes and improve health system efficiency.