Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study. (October 2016)

• Record Type: Journal Article
• Authors: D'Onofrio, Antonio; Stabile, Giuseppe; Capucci, Alessandro; Amellone, Claudia; De Simone, Antonio; Leoni, Loira; Morani, Giovanni; Bianchi, Valter; Campari, Monica; Valsecchi, Sergio; Buja, Gianfranco
• Is Part Of: Journal of telemedicine and telecare. Volume 22:Number 7(2016)
• Page Start: 383
• Page End: 390
• Publication Date: 2016-10
• Subjects: Implantable cardioverter defibrillator -- cardiac resynchronization therapy -- heart failure -- remote monitoring -- telemedicine; Telecommunication in medicine -- Periodicals; 610
• DOI: 10.1177/1357633X15613701
• Languages: English
• ISSNs: 1357-633X

Abstract

Introduction: A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months. Methods: Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients. Results: The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM ( p = 0.003) and the achievement of the effective dose of beta-blockers ( p = 0.006) were independently and positively associated with an improved outcome. Discussion: In a 'real-world' setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.