Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial.

Autor:	Boriani, Giuseppe, Da Costa, Antoine, Quesada, Aurelio, Ricci, Renato Pietro, Favale, Stefano, Boscolo, Gabriele, Clementy, Nicolas, Amori, Valentina, Mangoni di S. Stefano, Lorenza, Burri, Haran, MORE-CARE Study Investigators
Předmět:	DEFIBRILLATORS CARDIOVASCULAR disease treatment HEART transplantation HOSPITAL care EMERGENCY medical services HEART failure treatment CARDIAC pacemakers CARDIAC pacing CARDIOVASCULAR diseases COMPARATIVE studies PATIENT aftercare HOSPITAL emergency services LONGITUDINAL method RESEARCH methodology MEDICAL cooperation MORTALITY PATIENT monitoring RESEARCH STATISTICAL sampling TELEMEDICINE EVALUATION research RANDOMIZED controlled trials
Zdroj:	European Journal of Heart Failure; Mar2017, Vol. 19 Issue 3, p416-425, 10p, 1 Diagram, 4 Charts, 2 Graphs
Abstrakt:	Aims: The aim of this study was to evaluate the clinical efficacy and safety of remote monitoring in patients with heart failure implanted with a biventricular defibrillator (CRT-D) with advanced diagnostics.Methods and Results: The MORE-CARE trial is an international, prospective, multicentre, randomized controlled trial. Within 8 weeks of de novo implant of a CRT-D, patients were randomized to undergo remote checks alternating with in-office follow-ups (Remote arm) or in-office follow-ups alone (Standard arm). The primary endpoint was a composite of death and cardiovascular (CV) and device-related hospitalization. Use of healthcare resources was also evaluated. A total of 865 eligible patients (mean age 66 ± 10 years) were included in the final analysis (437 in the Remote arm and 428 in the Standard arm) and followed for a median of 24 (interquartile range = 15-26) months. No significant difference was found in the primary endpoint between the Remote and Standard arms [hazard ratio 1.02, 95% confidence interval (CI) 0.80-1.30, P = 0.89] or in the individual components of the primary endpoint (P > 0.05). For the composite endpoint of healthcare resource utilization (i.e. 2-year rates of CV hospitalizations, CV emergency department admissions, and CV in-office follow-ups), a significant 38% reduction was found in the Remote vs. Standard arm (incidence rate ratio 0.62, 95% CI 0.58-0.66, P < 0.001) mainly driven by a reduction of in-office visits.Conclusions: In heart failure patients implanted with a CRT-D, remote monitoring did not reduce mortality or risk of CV or device-related hospitalization. Use of healthcare resources was significantly reduced as a result of a marked reduction of in-office visits without compromising patient safety.Trial Registration: NCT00885677. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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