Long-Term Outcome After ICD and CRT Implantation and Influence of Remote Device Follow-Up: The ALTITUDE Survival Study
Open accessAbstract
Background—: Outcome data for patients receiving implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) devices treated outside of clinical trials are lacking. No clinical trial has evaluated mortality after device implantation or after shock therapy in large numbers of patients with implanted devices that regularly transmit device data over a network. Methods and Results—: Survival status in patients implanted with ICD and CRT devices across the United States from a single manufacturer was assessed. Outcomes were compared between patients followed in device clinic settings and those who regularly transmit remote data collected from the device an average of 4 times monthly. Shock delivery and electrogram analysis could be ascertained from patients followed on the network, enabling survival after ICD shock to be evaluated. One- and 5-year survival rates in 185 778 patients after ICD implantation were 92% and 68% and were 88% and 54% for CRT-D device recipients. In 8228 patients implanted with CRT-only devices, survival was 82% and 48% at 1 and 5 years, respectively. For the 69 556 ICD and CRT-D patients receiving remote follow-up on the network, 1- and 5-year survival rates were higher compared with those in the 116 222 patients who received device follow-up in device clinics only (50% reduction; P <0.0001). There were no differences between patients followed on or off the remote network for the characteristics of age, gender, implanted device year or type, and economic or educational status. Shock therapy was associated with subsequent mortality risk for both ICD and CRT-D recipients. Conclusions—: Survival after ICD and CRT-D implantation in patients treated in naturalistic practice compares favorably with survival rates observed in clinical trials. Remote follow-up of device data is associated with excellent survival, but arrhythmias that result in device therapy in this population are associated with a higher mortality risk compared with patients who do not require shock therapy.
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In a contemporary real-world ICD population, appropriate shocks occur in approximately 6% per year of ICD patients, and inappropriate shocks occur in approximately 8% per year.
“In a contemporary real-world ICD population, appropriate shocks occur in ≈6% per year of ICD patients, and inappropriate shocks occur in ≈8% per year.24”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [24]
The section “Shock Therapies and Programming in Patients Followed Up on the Network” reports the one-year figures in the opposite order: 8% appropriate shocks and 6% inappropriate shocks. The citing sentence reverses those rates. (LLM, conf=0.95)
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Experimental — accuracy not yet measuredIn the large but nonrandomized ALTITUDE study, the use of remote monitoring for ICD patients was associated with improved survival.
“In the large but nonrandomized ALTITUDE study, in which monitoring was continuous, the use of remote monitoring for ICD patients was associated with improved survival”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [24]
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- Authors
- Saxon, L. A., Hayes, D. L., Gilliam, F. R., Heidenreich, P. A., Day, J., Seth, M., Meyer, T. E., Jones, P. W., & Boehmer, J. P.
- Affiliations
- University of Southern California (US)
- ORCID
- Venue
- Circulation
- Published
- 2010-12-07
- Volume
- 122
- Issue
- 23
- Pages
- 2359-2367
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2034311573
- Cited by
- 515
- References
- 26
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 11 · 2023: 26 · 2022: 25 · 2021: 29 · 2020: 33 · 2019: 31 · 2018: 19 · 2017: 46 · 2016: 51 · 2015: 43 · 2014: 43 · 2013: 61 · 2012: 49
- FWCI
- 28.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- implantable cardioverter-defibrillator, CRT-D, remote device monitoring, mortality risk, device follow-up, electrogram analysis
- MeSH terms
- Aged, Aged, 80 and over, Altitude, Convulsive Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Survival Rate, Treatment Outcome, Defibrillators, Implantable, Cardiac Resynchronization Therapy, Remote Sensing Technology
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