Impact of Remote Monitoring on Long-Term Prognosis in Heart Failure Patients in a Real-World Cohort: Results From All-Comers COMMIT-HF Trial

J Cardiovasc Electrophysiol. 2017 Apr;28(4):425-431. doi: 10.1111/jce.13174. Epub 2017 Mar 7.


Background: Randomized controlled trials demonstrate that remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT-Ds) may improve quality of care and prognosis in heart failure (HF) patients. However, the impact of RM on long-term mortality in a real-world cohort is still not well examined.

Methods and results: This study was designed as a matched cohort study based on the COMMIT-HF trial--a single-center, ongoing prospective observational registry (NCT02536443). Complete patient demographics, medical history, in-hospital results, hospitalizations, and mortality data were collected based on institutional registries and healthcare providers' records. Patients were divided into 2 groups based on RM presence and matched by means of propensity scores according to clinical characteristics. The primary endpoint of this study was the long-term all-cause mortality. Out of 1,429 consecutive patients, 822 patients with a first implantation of an ICD/CRT-D were included in the analysis. The final matched study population contained 574 patients in RM and in a control group. Although demographic and echocardiographic parameters as well as pharmacological treatments were similar in both groups, a significantly lower 1-year mortality was detected in the RM group (2.1% vs. 11.5%, P < 0.0001). This was also maintained during a 3-year follow-up (4.9% vs. 22.3%, P < 0.0001). Multivariate analysis showed that RM was associated with an improved prognosis (hazard ratio 0.187, 95% confidence interval 0.075-0.467, P = 0.0003).

Conclusion: RM of HF patients with ICDs/CRT-Ds significantly reduced long-term mortality in a real-world clinical condition.

Keywords: heart failure; implantable cardioverter-defibrillators; mortality; outcome; remote monitoring.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cardiac Resynchronization Therapy
  • Cardiac Resynchronization Therapy Devices
  • Chi-Square Distribution
  • Defibrillators, Implantable
  • Electric Countershock / instrumentation
  • Female
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prognosis
  • Propensity Score
  • Proportional Hazards Models
  • Prospective Studies
  • Prosthesis Design
  • Registries
  • Risk Factors
  • Telemedicine / methods*
  • Telemetry*
  • Time Factors