Home monitored ICD patients are more loyal to follow up - the paradox of remote patient management in the Trust trial

Background: Concern exists that assigning patients to remote home monitoring (HM) causes attrition to follow up compared to regular scheduled in-person evaluations (IPE). This is important since HM is increasingly adopted in higher risk patients demanding heightened surveillance. The prospective TRUST Trial evaluated this. Methods: 1339 ICD patients were randomized post-implant 2:1 to automatic HM or to Conventional monitoring (CM), with follow-up checks scheduled at 3, 6, 9, 12 and 15 months post-implant. Conventional patients were evaluated with IPE only. HM pts were assessed remotely but 3 and 15 month checks were followed by IPEs, thus maintaining yearly face-to-face examination. Each follow mechanism was assessed for i) patient attrition during the trial (withdrawal and lost to follow up) and ii) adherence to mandated IPE. Results: HM (n= 908) and CM (n=431) patients were similar (age 63yrs, 72% male, LVEF 29%, primary prevention 73%, DDD 57%). (Figure 1) i) Patient attrition during the trial was 42% greater in CM (87/431 vs HM 129/908, p=0.007) ie HM secured more durable follow-up. ii) IPE failure rates were 62% greater in CM (193/1841 vs HM (97/1484, p<0.001) ie HM patients remained more engaged with clinic services. ![Figure][1] Figure 1 Conclusion: Automatic remote monitoring better preserves patient retention and adherence to scheduled follow up, forcing a reevaluation of the traditional gold standard built on in-person evaluation only. [1]: pending:yes