ESC Congress 2016 - 15

Your FREE access to ESC Congress content all year long www.escardio.org/365 ESC CONGRESS 2016 IN REVIEW Table 1. Results for the Primary Outcome and Its Components Figure 1. Rates of Health Care Utilization for CV Reasons Cardiovascular hospitalizations Emergency department admissions for cardiovascular reason Outpatient visits: unscheduled unplanned Outpatient visits: unscheduled planned Outpatient visits: scheduled IRR, 0.62 (95% CI, 0.58 to 0.66); P < .001 6.0 n = 200 5.5 Two-Year Rate of Health Care Utilization and on optimal medical therapy), no permanent atrial fibrillation or atrial tachycardia, and not have been previously implanted with a biventricular CRT-D [Boriani H et al. Am Heart J. 2010]. Within 8 weeks from de novo implant of a CRT-D, patients were randomized to undergo remote checks alternated with in-office follow-ups (Remote arm; n = 437) or to in-office follow-ups alone (Standard arm; n = 428). Frequency of remote checks and/or in-office follow-ups was 4 months for both arms, with automated alerts for pulmonary congestion and atrial arrhythmias only active among the remote monitoring arm. Study participants were a mean age of 66 years; 76% were men. Mean left ventricular ejection fraction was 27%. The median follow-up was 24 months. There were no significant differences for the composite primary endpoint or its components (Table 1). n = 29 n = 32 n = 52 5.0 4.5 n = 1789 4.0 n = 197 3.5 n = 23 n = 40 3.0 n = 207 2.5 2.0 n = 867 1.5 1.0 Remote (n = 437) Standard (n = 428) Hazard Ratio (95% CI) P Value Primary composite endpoint, n (%) Death or first CV or D-R hospitalization* 130 (29.7) 123 (28.7) 1.02 (0.80-1.30) .889 Death from any cause 40 (9.2) 34 (7.9) 1.13 (0.71-1.80) .594 First CV hospitalization 100 (22.9) 97 (22.7) 0.96 (0.73-1.28) .796 First D-R hospitalization 17 (3.9) 18 (4.2) 0.89 (0.44-1.79) .742 Components, n (%) CV, cardiovascular; D-R, device-related. *≥ 48-hour stay. Reprinted from Boriani G et al. 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. Eur J Heart Fail. 2016; Epub ahead of print. doi:10.1002/ejhf.626. By permission of John Wiley and Sons on behalf of the European Society of Cardiology. For the secondary outcome, there was a significant 38% reduction on the composite endpoint of health care resource utilization for CV reasons in the remote monitoring group (incidence rate ratio, 0.62; 95% CI, 0.58 to 0.66; P < .001; Figure 1). The 2-year rates of a composite of CV hospitalizations, CV ED admissions, and CV in office follow-up were 3.7 per 100 patients (95% CI, 3.5 to 3.9) versus 6.0 per 100 patients (95% CI, 5.7 to 6.2) for the Remote and Standard groups, respectively. 0.5 0.0 Standard Arm Remote Arm IRR, incidence rate ratio. Reprinted from Boriani G et al. 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. Eur J Heart Fail. 2016; Epub ahead of print. doi:10.1002/ejhf.626. By permission of John Wiley and Sons on behalf of the European Society of Cardiology. Patients in the remote monitoring group had significantly fewer outpatient visits as well as significantly fewer device-related ED visits not leading to hospitalization (both P < .001). The rates of hospitalization were not significantly different nor were the rates for other than device-related ED visits. Thus, MORE-CARE did not translate into more survival among symptomatic HF patients treated with a CRT-D device. Nevertheless remote monitoring may be an interesting option to further study given the favorable cost savings of remote monitoring without compromising patient safety. REM-HF: The Value of Remote Monitoring for Heart Failure Patients Written by Maria Vinall Data from the remote monitoring of heart failure study [REM-HF; ISRCTN96536028] presented by Martin R. Cowie, MD, Imperial College London, Royal Brompton Hospital, London, United Kingdom, suggests that in developed health care systems with high-quality heart failure Official Peer-Reviewed Highlights From ESC Congress 2016 15 http://www.escardio.org/365

Table of Contents for the Digital Edition of ESC Congress 2016