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Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial.


ABSTRACT:

Aims

In the IN-TIME trial, automatic daily implant-based multiparameter telemonitoring significantly improved clinical outcomes in patients with chronic systolic heart failure and implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D). We compared IN-TIME results for ICD and CRT-D subgroups.

Methods

Patients with LVEF???35%, NYHA class II/III, optimized drug treatment, no permanent atrial fibrillation, and a dual-chamber ICD (n?=?274) or CRT-D (n?=?390) were randomized 1:1 to telemonitoring or no telemonitoring for 12 months. Primary outcome measure was a composite clinical score, classified as worsened if the patient died or had heart failure-related hospitalization, worse NYHA class, or a worse self-reported overall condition.

Results

The prevalence of worsened score at study end was higher in CRT-D than ICD patients (26.4% vs. 18.2%; P?=?0.014), as was mortality (7.4% vs. 4.1%; P?=?0.069). With telemonitoring, odds ratios (OR) for worsened score and hazard ratios (HR) for mortality were similar in the ICD [OR?=?0.55 (P?=?0.058), HR?=?0.39 (P?=?0.17)] and CRT-D [OR?=?0.68 (P?=?0.10), HR?=?0.35 (P?=?0.018)] subgroups (insignificant interaction, P?=?0.58-0.91).

Conclusion

Daily multiparameter telemonitoring has a potential to reduce clinical endpoints in patients with chronic systolic heart failure both in ICD and CRT-D subgroups. The absolute benefit seems to be higher in higher-risk populations with worse prognosis.

SUBMITTER: Geller JC 

PROVIDER: S-EPMC6753058 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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