Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators
Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators
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DOI：
10.1161/circep.114.003030
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发表时间：
2015-10-01
影响因子：
8.4
通讯作者：
Curtis, Jeptha P.
中科院分区：
文献类型：
--
作者：
Akar, Joseph G.;Bao, Haikun;Curtis, Jeptha P.
背景 我们研究了植入式心律转复除颤器 (ICD) 的远程患者监护 (RPM) 的使用与初次植入 ICD 的患者的全因死亡率和再住院之间的关联。方法和结果从 2006 年 1 月至 2010 年 3 月期间从波士顿科学海拔登记处和国家心血管数据登记处 ICD 登记处构建了有限的数据集。使用社会保障死亡主文件确定生命状态。对使用 RPM 的患者与未使用 RPM 的患者长达 3 年的全因死亡率进行了比较。时间依赖性衰弱 Cox 模型量化了 RPM 使用与全因死亡率之间的关联。根据年龄、性别、种族、ICD 类型、适应症和心肌病发病机制在亚组中重复进行分析。类似的方法研究了参加 Medicare 按服务付费患者 65 年的患者中 RPM 使用与全因再住院之间的关联。研究队列（n=37742，年龄 6713，72% 为男性）的 3 年死亡率为 20.9%（中位随访时间 832 天）。在多变量分析中，与不使用 RPM 的患者相比，使用 RPM 的患者（n=22023，58%）的死亡风险较低（风险比 0.67，95% 置信区间 0.64-0.71，P
Background We examined the association between the use of remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICD) and all-cause mortality and rehospitalization among patients undergoing initial ICD implant.Methods and Results A limited data set was constructed from Boston Scientific ALTITUDE Registry and National Cardiovascular Data Registry ICD Registry between January 2006 and March 2010. Vital status was determined using the Social Security Death Master File. All-cause mortality up to 3 years was compared in patients who used RPM with those who did not use RPM. Time-dependent frailty Cox models quantified the association between RPM use and all-cause mortality. Analyses were repeated in subgroups based on age, sex, race, ICD type, indication, and cardiomyopathy pathogenesis. Similar methodology examined the association between RPM use and all-cause rehospitalization in patients enrolled in Medicare fee-for-service patients 65 years. The study cohort (n=37742, age 6713, 72% male) had a 3-year mortality of 20.9% (median follow-up 832 days). In multivariable analyses, patients using RPM (n=22023, 58%) had lower risk of mortality compared with those not using RPM (hazard ratio 0.67, 95% confidence interval 0.64-0.71, P