1. Stroke incidence in patients with cardiac implantable electronic devices remotely controlled with automatic alerts of atrial fibrillation. A sub-analysis of the HomeGuide study
- Author
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Antonio D'Onofrio, Leonardo Calò, Alessio Gargaro, Ennio Pisano, Renato Pietro Ricci, Diego Vaccari, Nicola Rovai, Antonio Curnis, Vittorio Calzolari, Donato Melissano, Marco Brieda, Loredana Morichelli, Gabriele Zanotto, and René Nangah
- Subjects
Male ,medicine.medical_specialty ,Pacemaker, Artificial ,medicine.medical_treatment ,Population ,Management of atrial fibrillation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Risk factor ,education ,Stroke ,Aged ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Implantable cardioverter-defibrillator ,Confidence interval ,Telemedicine ,Defibrillators, Implantable ,Cardiology ,Electrocardiography, Ambulatory ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Remote Monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended in management of Atrial Fibrillation (AF), which is a recognized risk factor for thromboembolism. We tried to elucidate whether stroke incidence observed in a large, remotely monitored population was consistent with the CHA2DS2VASc risk profile.Data from 1650 patients [76% male, age 72 (63-68), CHA2DS2VASc score 3.0 (2.0-4.0)] enrolled during the HomeGuide study and monitored with a daily-transmission RM system providing automatic alerts for AF, were analysed. Of those, 25% had a pacemaker and 75% an implantable cardioverter defibrillator with or without cardiac resynchronization. Estimations of the expected thromboembolic events were based on the population CHA2DS2VASc score profile used in a computer-simulated Markov model.Eight thromboembolic events were observed with a 4-year cumulative stroke rate of 0.8% (confidence interval, 0.4%-1.5%). Simulations returned from 18.7 to 17.1 expected events, depending on the AF duration assumed to trigger anticoagulation (one-sample log-rank p0.03). During the study period, 681 (84%) AF episodes and 129 (16%) atrial tachycardias were detected in 291 patients (18%): 93% of episodes were detected remotely in 269 patients, 66% of whom had no history of AF. Medical interventions were necessary in 305 episodes, 85% of which were detected remotely. Reaction time was 1 (0-6) days for remotely-detected episodes and 33 (14-121) days for episodes detected in clinic (p0.0001).In a large CIED population followed remotely for up to 4years, the incidence of thromboembolic events was less than half the estimations based on the CHA2DS2VASc risk profile.
- Published
- 2016