Cost‐effectiveness of early detection of atrial fibrillation via remote control of implanted devices

Rationale, aims and objectives Atrial fibrillation ( AF ) is an independent risk factor for stroke, and its incidence is high in patients implanted with pacemakers ( PMs ) and implantable cardioverter defibrillators ( ICDs ). The aim of our study is to evaluate the potential benefit of remote control ( RC ) on the incidence of stroke related to AF in patients with new‐onset AF implanted with PM s and ICD s and to evaluate the impact of RC on the consumption of medical resources. Method The study consisted of two cohorts of patients: group AMB (patients attending ambulatory care clinics from A ugust to O ctober 2013) and group RC (patients followed remotely). All detected cases of new‐onset AF were confirmed by the electrogram stored in the device's memory or by standard electrocardiogram recording. M onte C arlo simulations were performed in order to evaluate the potential risk reduction of stroke related to AF . The costs were estimated from the perspectives of the hospital, the patients and the N ational H ealth S ervice. Result We enrolled 223 patients in group RC and 359 in group AMB . We detected 20 new‐onset cases of AF , and the median time to AF detection was 2 days in the RC and 78 days in the ambulatory care clinic control. Management of patients was more efficient with RC , with an average savings in direct costs of €40.88 per year per patient. Through the use of M onte C arlo simulations, we showed that the early detection of new‐onset AF may provide a relative risk reduction of 94.3% for stroke in PM ‐implanted patients older than 55 years. Conclusion RC potentially provides a risk reduction for stroke because it allows an early detection of new‐onset AF . Moreover, it is also a cost‐saving means of follow‐up.