Abstract 12698: Alert-Driven versus Scheduled Remote Monitoring of Implantable Cardiac Defibrillators: An Economic Analysis From the Trust Randomized Trial
Bibliographic record
Abstract
Introduction: Current implementation of remote patient monitoring (RPM) for implantable cardioverter defibrillators (ICDs) involves a hybrid of remote assessment and in-person evaluation (IPE) every 3 months. Alert-driven RPM or fully virtual care without routine visits may reduce non-actionable patient evaluation, increased clinic workload and inefficient resource allocation. Objective: To conduct a cost-consequence analysis to compare three patient management strategies following ICD implantation: (a) IPE only, (b) RPM-conventional (hybrid of IPE and RPM), and (c) RPM-alert (alert-based ICD follow up). Methods: We constructed a decision-analytic Markov model to estimate the costs and benefits of three strategies of patient management following ICD implantation over a two-year time horizon from the perspective of the US healthcare system. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of non-actionable encounters. Cost data was obtained from the published literature. The primary outcome was incremental cost. Results: The mean cumulative costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval (CI)-$2,138 to +$638) and -$1,677 (95% CI -$3,134 to -$304), respectively. Of the three groups, the RPM-alert strategy was the most cost-effective strategy with an estimated cost-savings in 99% of simulations. Conclusions: Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to conventional RPM, may be the preferred strategy of patient follow up.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".