scholarly journals Cost Effectiveness of Implantable Cardiac Monitor-Guided Intermittent Anticoagulation for Atrial Fibrillation: An Analysis of the REACT.COM Pilot Study

2016 ◽  
Vol 27 (11) ◽  
pp. 1304-1311 ◽  
Author(s):  
DANIEL A. STEINHAUS ◽  
PETER J. ZIMETBAUM ◽  
ROD S. PASSMAN ◽  
PETER LEONG-SIT ◽  
MATTHEW R. REYNOLDS
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Pilot Study ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract 336: Cost-effectiveness of Implantable Cardiac Monitor-guided Intermittent Anticoagulation for Paroxysmal Atrial Fibrillation

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Daniel A Steinhaus ◽  
Peter J Zimetbaum ◽  
Rod S Passman ◽  
Peter Leong-Sit ◽  
Matthew R Reynolds
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Pilot Study ◽  
Continuous Treatment ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Cardiac Monitor ◽  
Life Years ◽  
Expected Outcomes ◽  
Implantable Cardiac Monitor

Background: Patients with atrial fibrillation (AF) and stroke risk factors are recommended for treatment with long-term anticoagulation, even when rhythm control interventions result in a low AF burden. A strategy of guiding anticoagulation with novel oral anticoagulants (NOACs) based on daily transmissions from an implantable cardiac monitor (ICM) in CHADS 2 1 or 2 AF patients has recently been explored in a single-arm pilot study. The aim of our study was to evaluate the cost-effectiveness of this strategy versus projected outcomes with the current standard of continuous anticoagulation. Methods: We developed a Markov model using data from the Rhythm Evaluation for AntiCoagulaTion With COntinuous Monitoring (REACT.COM) pilot study (N=59) and previously completed anticoagulant trials to calculate the costs and quality-adjusted life years (QALYs) associated with ICM-guided intermittent anticoagulation for AF vs. standard care. The model time horizon was 3 years (the battery life of an ICM). Health state utilities were estimated from the pilot study population using the SF-12. Costs were based on current Medicare reimbursement. Results: In the pilot study, over 14±4 months of follow-up 18/59 patients were observed to have 35 AF episodes, 60% of which spontaneously terminated and 63% were asymptomatic. The protocol resulted in a >90% reduction in anticoagulant use relative to standard continuous treatment. There were no strokes, 2 (3.4%) TIAs, 2 major bleeding events (on aspirin) and 3 minor bleeding events with the ICM-guided strategy. The model projected total 3-year costs of $10,558 for the ICM-guided strategy vs. $12,898 for literature-based expected outcomes with continuous anticoagulation. Projected QALYs were 2.46 for both groups. Detailed sensitivity and scenario analyses are ongoing. Conclusions: Based on the REACT.COM pilot study, a strategy of intermittent, ICM-guided oral anticoagulation with NOACs was cost-saving relative to expected outcomes with continuous anticoagulation, with equivalent quality-adjusted survival. This strategy requires validation in a larger, randomized study.

scholarly journals Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor

2021 ◽  
Vol 34 ◽  
pp. 100791
Author(s):  
Victoria Jansson ◽  
Lennart Bergfeldt ◽  
Jonas Schwieler ◽  
Göran Kennebäck ◽  
Aigars Rubulis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Cardiac Monitor ◽  
Episode Duration ◽  
Atrial Fibrillation Burden ◽  
Implantable Cardiac Monitor

scholarly journals Implantable cardiac monitor after cryptogenic stroke: atrial fibrillation detection and predictors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Ebrille ◽  
C Amellone ◽  
M.T Lucciola ◽  
F Orlando ◽  
M Suppo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Risk Stratification ◽  
Median Time ◽  
Remote Monitoring ◽  
Cryptogenic Stroke ◽  
Screening Process ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract Objective The main objective of our study was to analyze the incidence and predictors of atrial fibrillation (AF) in patients with cryptogenic stroke (CS) who received an implantable cardiac monitor (ICM) at our Institution. Methods From November 2013 to October 2017, a total of 133 patients who had suffered a CS were implanted with an ICM after a thorough screening process. The median time between the thromboembolic event and ICM implantation was 64 days [IQ range: 16–111]. All implanted patients were followed with remote monitoring until the first detected episode of AF or up to December 2018. Every remote monitoring transmission and related electrograms were analyzed by the dedicated Electrophysiology Nursing team and confirmed by experienced Electrophysiologists. AF was defined by any episode lasting greater than or equal to 2 minutes. Results During a median follow-up of 14.8 months [IQ range: 3.0–31.2], AF was detected in 65 out of 133 patients (48.9%). The median time from ICM implantation and AF detection was 3.5 months [IQ range: 0.9–6.7]. The prevalence of AF was 22.6%, 34.4%, 40.8% and 48.3% at 3, 6, 12 and 24 months respectively. At the multivariate analysis, high premature atrial contractions (PAC) burden and left atrium (LA) dilation were the only independent predictors of AF detection (HR 2.82, 95% CI 1.64–4.83, p<0.001 for PAC; HR 1.75, 95% CI 1.03–2.97, p=0.038 for LA dimension). Patients were dived into categories based on the probability of AF detection (low, intermediate and high risk) and a new risk stratification algorithm was implemented (Figure 1). Conclusion After a thorough screening process, AF detection in patients with CS and ILM was quite high. Having a high PAC burden and LA dilation predicted AF episodes at the multivariate analysis. A new risk stratification algorithm was developed. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Implantable Cardiac Monitor Compared with Conventional Diagnostic for Unexplained Syncope: A Combined Cost-Effectiveness and Budget-Impact Analysis

2018 ◽  
Vol 21 ◽  
pp. S166
Author(s):  
RC Lucchetta ◽  
BS Riveros ◽  
MP Rosim ◽  
P Holanda ◽  
M Melo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis ◽  
Cardiac Monitor ◽  
Unexplained Syncope ◽  
Implantable Cardiac Monitor

scholarly journals 97-01: BioMonitor 2 Pilot Study: First experience with the Biotronik BioMonitor 2 implantable cardiac monitor

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i171-i171
Author(s):  
Ben Ng ◽  
Suresh Singarayar ◽  
Kevin Hellestrand ◽  
Peter Illies ◽  
Uwais Mohamed ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

BioMonitor 2 Pilot Study: Early Experience With Implantation of the Biotronik BioMonitor 2 Implantable Cardiac Monitor

2018 ◽  
Vol 27 (12) ◽  
pp. 1462-1466 ◽  
Author(s):  
Sze-Yuan Ooi ◽  
Ben Ng ◽  
Suresh Singarayar ◽  
Kevin Hellestrand ◽  
Peter Illes ◽  
...  
Keyword(s):  
Pilot Study ◽  
Early Experience ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

scholarly journals 287TIME TO INITIAL DETECTION OF ATRIAL FIBRILLATION [AF] WITH IMPLANTABLE CARDIAC MONITOR [ICM] IN CRYPTOGENIC STROKE

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii1.50-ii12
Author(s):  
Nkechi Uzomefuna ◽  
Frederick Okpoko ◽  
Hafiz Hussein ◽  
David Williams ◽  
Brendan McAdam
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor
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