遠隔モニターはイベントから方針決定までの時間を短縮する

A wireless monitoring system that automatically sends information about arrhythmias from a device in the patient's chest to the cardiologist's office significantly cuts the time between when a problem arises and a treatment decision is made, according to research presented at the American College of Cardiology's 59th annual scientific session.

The Clinical Evaluation Of Remote Notification to Reduce Time to Clinical Decision (CONNECT) evaluated a wireless remote monitoring and notification system based on Medtronic's Conexus-enabled cardiac resynchronization therapy defibrillators (CRT-Ds) and implantable cardioverter-defibrillators (ICDs). The wireless telemetry system was compared with standard care, in which a cardiologist reviews information from an implanted device during an in-person clinic visit. The study showed that remote monitoring and automatic notification cut by nearly two-thirds the time to clinical decision-making.

"This system allows the clinician to better manage the patient's disease by making critical information immediately available," said George H. Crossley, M.D., president of Mid-State Cardiology, a unit of St. Thomas Heart, and a clinical professor of medicine at the University of Tennessee College of Medicine, both in Nashville, TN. "By learning about clinical events earlier, we have the opportunity to intervene earlier, improve outcome and prevent disease progression."

The use of remote monitoring for follow-up of CRT-D or ICD, has the potential to improve both patient safety and healthcare efficiency. CONNECT is the largest randomized, prospective study designed to quantify these advantages.

For the study, researchers from 136 sites in the United States recruited 1,997 patients with an ICD or CRT-D, randomly assigning them to remote monitoring or standard in-office care. All patients were followed-up for 15 months after device implantation. Those in the remote-monitoring group were given a home monitor capable of receiving a wireless telemetry signal from the implanted device and automatically transmitting diagnostic information to the cardiologist's office over a telephone line, without any action on the patient's part. The devices were programmed to send routine information on a schedule determined by the cardiologist, and to immediately send alerts in the case of a worrisome development. Patients in the remote-monitoring group were seen in the office 1 month and 15 months after device implantation only. Patients receiving standard care were followed-up in the office on a fixed schedule, typically every three to six months, without remote monitoring.

Data from CONNECT showed a significant reduction in the time between the onset of a clinical problem and a clinical decision on how to manage it (29.5 days, on average, in the standard-care group vs. 10.5 days, on average, in the remote-monitoring group). There was also a significant reduction in the average length of hospitalization (4.0 days vs. 3.3 days, respectively), which resulted in an estimated savings of $1,659 per hospitalization, on average, for patients in the remote-monitoring group.

"Although in our current analysis we were not able to determine the direct mechanism of this reduction in the length of stay, this is the first trial to show a correlation between remote management and significant positive changes to healthcare utilization," Dr. Crossley said.

CONNECT was funded by Medtronic. Dr. Crossley reports receiving speaker and research and consulting fees from Medtronic, speaker fees from Guidant, and research support from St. Jude Medical.