"This is a very important observation," said Dr. Sidney Goldstein of Henry Ford Hospital, Detroit, who co-moderated a press briefing that included the two studies.
Dr. Kacet said the investigators will perform a secondary analysis of costs in the two monitoring groups soon. The cost analysis is important, because it is not known if the cost of resources to analyze the increased data from home monitoring outweighs potential financial benefits from reduced shocks and prolonged battery life, Dr. Gordon F. Tomaselli said in an interview.
U.S. patients with ICDs often have more than one doctor managing their care. If home monitoring can eliminate some visits to their primary care doctor, cardiologist, or electrophysiologist, this could make an important difference in convenience and costs, said Dr. Tomaselli, president of the American Heart Association and chief of cardiology at Johns Hopkins University, Baltimore.
"We use remote monitoring now for people who find it difficult to get back to our arrhythmia center to be evaluated. I don’t think [these studies] will change things too much in the way of what we do," he said. "For people who are very close, it’s oftentimes not inconvenient for them to come see us face-to-face."
The studies also add to evidence from two previous randomized controlled trials that relied on surrogate end points to evaluate remote ICD monitoring. One study of 1,339 patients reported a 45% reduction in in-office device evaluations among remotely monitored patients without affecting safety (Circulation 2010;122:325-32). A separate study of 1,997 patients found that remote monitoring reduced the time from an ICD-related event to a clinical decision from 22 days to 5 days, and reduced the length of cardiovascular-related hospital stays from an average of 4.0 days to 3.3 days (J. Am. Coll. Cardiol. 2011;57:1181-9).
Biotronik funded the ECOST study. Dr. Kacet has received research funding from Biotronik, Boston Scientific, Medtronic, Saint Jude Medical, Sorin Group, Bayer, Boehringer-Ingelheim, Meda, and Sanofi-Aventis. Dr. Mabo has been a speaker, consultant, or investigator for all five companies making implantable cardiac devices. Dr. Auricchio has been a consultant to all companies making implantable cardiac devices. Dr. Tomaselli said he has no conflicts of interest.