Big Brother is watching you: what do patients think about ICD home monitoring?

Patients with implantable cardioverter-defibrillators (ICDs) are burdened with frequent visits to their doctors. Current guidelines suggest that patients should be seen every three to six months to have their devices interrogated and to make adjustments.1 The majority of these visits do not result in programming or device changes.2 Given the growth in the number of patients receiving ICDs, the burden on clinics to meet these interrogation guidelines is increasing. The Lumos-T Safely RedUceS RouTine Office Device Follow-up (TRUST) trial, published in this issue of Circulation , reports the results of an intervention that could improve the quality of care for patients with ICDs by decreasing the number of ICD follow-up visits while simultaneously providing closer monitoring of the ICD.3 The Institute of Medicine has stated that quality health care is care that is safe, effective, patient-centered, timely, equitable, and efficient4; the TRUST trial should be both praised and criticized based on these quality domains. Article see p 325 The TRUST trial was a large, multi-center, randomized trial of 1339 patients designed to test a new home monitoring (HM) system against routine medical care for the ongoing surveillance of ICDs. The HM system evaluates a patient's ICD daily through a remote monitoring device that allows clinicians to intervene earlier if and when abnormalities are detected. As such, patients would then only have to have their ICDs interrogated in person once a year. The authors specified two a priori primary end points for their HM trial, one for efficacy and one for safety.5 The efficacy end point was to show that HM decreased the number of office-based ICD follow-up visits; the safety end point (appropriately powered to test noninferiority) was to show that the HM system did not increase death, stroke, or surgical interventions when compared …