HRS.15: Remote monitoring leads to cost savings, fewer hospitalizations

BOSTON—Patients who had remote monitoring in their implantable electronic cardiac devices had lower all-cause hospitalization costs and recurrent hospitalizations compared with patients without remote monitoring capabilities, according to a large, retrospective, cohort study.

After adjusting for patients’ age, sex and geographic location, there was an 18 percent reduction in all-cause hospitalization associated with the use of remote monitoring. The benefit was consistent across all devices from all manufacturers, including patients with pacemakers who did not have high-voltage devices.

Researchers also found that remote monitoring was associated with a $3,700 reduction in costs per patient year. They estimated that for every 100,000 patient-years, the use of remote monitoring was associated with 9,810 fewer hospitalizations, 119,000 fewer days in the hospital and more than $370,000 savings in hospital costs.

Lead researcher Jonathan P. Piccini, MD, of Duke University Medical Center in Durham, N.C., presented the results on May 14 during a late-breaking clinical trials session at Heart Rhythm 2015.

“We learned that in routine clinical practice in this nationwide sample, we saw that remote monitoring was associated with improved clinical outcomes,” Piccini said. “And those improved clinical outcomes were associated with significant decreases in healthcare expenditures for all-cause hospitalization.”

Piccini said observational studies and clinical trials have shown that remote monitoring improves survival and provides earlier detection of arrhythmias, bleeding abnormalities and device failure. It also can help identify patients at risk for heart failure and hospitalization.

In this study, the researchers analyzed remote monitoring use in adult patients who received pacemakers, implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices in the U.S. between April 1, 2008 and March 31, 2013. They analyzed data from the Truven Health Analytics MarketScan commercial and Medicare supplemental claims databases. They excluded patients who were not followed up within a year and those who did not have a clinical evaluation in their first 120 days after implant.

Of the 92,566 patients who met the inclusion criteria, 34,259 had remote monitoring and 58,307 did not have remote monitoring. Piccini said 59 percent of patients received pacemakers, 30 percent received ICDs and 11 percent received CRT devices. Remote monitoring was used in 29 percent of the pacemakers, 49 percent of the ICDs and 51 percent of the CRT devices.

At baseline, the mean age was 72, and 63 percent of patients were male. The degree of comorbid illness was similar in the two groups. However, patients who had remote monitoring had a higher prevalence of heart failure and prior ventricular arrhythmia, while those who did not have remote monitoring were more likely to have atrial fibrillation or prior cardiovascular disease.

Among patients who were hospitalized, the mean length of stay was 5.3 days in the remote monitoring group and 8.1 days in the group that did not have remote monitoring. The difference was statistically significant.

The magnitude of the lower risk of hospitalization was greater in ICD recipients and patients with CRT devices compared with those who received pacemakers.

There was a 43 percent reduction in all-cause hospitalization costs in ICD recipients and a 45 percent cost reduction in CRT device recipients, which Piccini said was associated with an $11,000 reduction in healthcare expenditures per year.

In patients with a prior diagnosis of heart failure, use of remote monitoring was associated with a 31 percent reduction in costs and a statistically significant decrease in length of hospital stay of 2.5 days. Piccini added that remote monitoring was associated with a lower magnitude of heart failure rehospitalization rates at 30, 90 and 180 days.

Piccini mentioned the study had a few limitations, including its retrospective design and reliance on observational data and only hospitalization costs.

“One important limitation of our study is we can’t distinguish between a remote monitoring transmission that was done because a doctor or a patient had a concern and a remote monitoring transmission that was done as part of the routine follow-up,” Piccini said.

However, he said that the researchers analyzed a large number of patients, adjusted for 22 clinical comorbid conditions and included all device manufacturers and devices.