The remote monitoring of EP devices has grown considerably in recent years. Today, hundreds of thousands of patients are implanted with cardiac rhythm management (CRM) devices that are capable of being monitored remotely (i.e., outside of a device clinic). The operational advantages of remote monitoring are obvious and easily demonstrated: a remote device-check takes less than half the time as an in-office check and eliminates 50 to 75 percent of clinic visits for routine check-ups. For these reasons, electrophysiologists have been quick to adopt the technology.
With the operational advantages well-understood, physicians are now trying to determine the clinical advantages of the technology. Today in Atlanta, Dr. George Crossley presented findings from the Clinical Evaluation Of Remote Notification to Reduce Time to Clinical Decision (CONNECT) trial. The trial used a wireless remote monitoring and notification system available through Medtronic's Conexus-enabled ICDs and CRT-Ds and compared its use to standard in-person clinic visits. The study showed that remote monitoring with automatic notification cut the time to clinical decision making by nearly two-thirds.
The largest randomized, prospective study designed to quantify the advantages of remote monitoring with automatic notifications, CONNECT followed nearly two thousand ICD and CRT-D patients at 136 sites in the United States. Data from the study showed a sizeable reduction in the time between the onset of an arrhythmic problem and a clinical decision on how to manage it (an average of 29.5 days in the standard-care group vs. 10.5 days in the remote-monitoring group). There was also a reduction in length of stay (LOS) for remote-monitored patients that had to be hospitalized, which Dr. Crossley estimated resulted in hospital savings of approximately one million dollars.
One interesting aspect of the remote-monitoring data was the gap in time between a notification and a clinical decision, which could be as long as 4 to 5 days. Dr. Crossley suggested this may show a 'Laissez-Faire' attitude among physicians to respond to data, but it may also reflect that the data does not carry an imperative for immediate action. We often hear complaints about data overload, a complaint that will only grow as more and more devices start transmitting an endless stream of bits and bytes. Could it be that the speed of data transmission may have out-paced its clinical need?