Virtual monitoring matches clinic care for heart-device patients

A report from an implanted heart device can now travel to a physician without the patient first travelling to a clinic. In Canada, the VIRTUES system matched standard care in two randomized trials involving 1,115 patients with pacemakers or implantable cardioverter defibrillators (ICDs), followed for 18 months across 13 centers.

The system works through transmission reports sent by the implanted device. A physician reviews the information and messages the patient about how well the device is working. Patients assigned to VIRTUES received remote monitoring with virtual-care communications only, while the standard-care group had in-clinic visits, with or without remote monitoring; both groups could receive unscheduled visits when device concerns arose.

The main safety result held in both trials. Death, stroke, or cardiovascular- or device-related hospitalization occurred in 11.0% versus 11.2% of patients in the ICD trial, and 6.1% versus 7.4% in the pacemaker trial. The researchers reported non-inferiority, meaning virtual care was not shown to be worse than standard care on that measure. For the time between an important clinical event and a clinic decision, the ICD trial found no difference, while the pacemaker trial showed a median difference of −3.25 days.

And then what? For patients, the practical gain is fewer routine trips to specialist clinics and more direct information about whether their device is working. For the health system, the adjusted total cost difference was 77 Canadian dollars per patient, mainly because of fewer in-clinic visits. Parkash estimated that the system could save around $10 million annually in Canada alone, and the researchers said most patients would continue using it if given the opportunity.

The result is promising but not yet global proof. The trials were conducted only in Canada, and the system would need further study in other regions before wider use could be assessed. Professor Ratika Parkash of Dalhousie University said VIRTUES could be scalable globally, while the trial results show where that possibility currently stands: tested in Canada, not yet established everywhere.