1. Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes J Am Coll Cardiol. 2015;65(24):2591-2600. doi:10.1016/j.jacc.2015.04.029 RCT Search Flow Diagram From a total of 4,382 citations, 9 randomized controlled trials (RCT) were selected to compare remote monitoring (RM) with in-office (IO) follow-up in implantable cardioverter-defibrillator (ICD) patients. Figure Legend:

2. Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes J Am Coll Cardiol. 2015;65(24):2591-2600. doi:10.1016/j.jacc.2015.04.029 All-Cause Mortality All-cause mortality data were available for 7 RCTs, comprising 4,932 patients. The odds ratio for mortality with RM was not statistically significant from IO follow-up. Exclusion of the IN-TIME trial reduced the trend toward reduced mortality with RM and eliminated between-study heterogeneity. CI = confidence interval; CONNECT = Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision; ECOST = Effectiveness and Cost of ICDs Follow-up Schedule with Telecardiology; EVOLVO = Evolution of Management Strategies of Heart Failure Patients with Implantable Defibrillators; IN-TIME = Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function; MORE-CARE = Monitoring Resynchronization Devices and Cardiac Patients; TRUST = Lumos-T Safely Reduces Routine Office Device Follow-up; other abbreviations as in Figure 1. Figure Legend:

3. Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes J Am Coll Cardiol. 2015;65(24):2591-2600. doi:10.1016/j.jacc.2015.04.029 Effect of RM on Patient Safety and Survival Remote monitoring (RM) has been proposed as an alternative to in-office (IO) follow-up of implantable cardioverter-defibrillators (ICD) to reduce the need for office visits while providing continuous surveillance and review of device data as well as immediate problem notification. In this meta-analysis of 9 randomized clinical trials comparing the 2 strategies, RM demonstrated a nonsignificant trend toward reduced cardiovascular mortality (p = 0.103) (A) and a significant reduction in inappropriate shocks (p = 0.002) (B). Although RM did not demonstrate any significant change in prevalence of atrial arrhythmia detection (C), it did significantly decrease time to clinical decision/event detection compared with IO follow-up, with a mean difference in days to clinical decision/event detection of –27.1 days (p < 0.001) (D). CI = confidence interval; CONNECT = Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision; ECOST = Effectiveness and Cost of ICDs Follow-up Schedule with Telecardiology; EVATEL = Evaluation of Tele Follow-up; EVOLVO = Evolution of Management Strategies of Heart Failure Patients with Implantable Defibrillators; IN-TIME = Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function; MORE-CARE = Monitoring Resynchronization Devices and Cardiac Patients; TRUST = Lumos-T Safely Reduces Routine Office Device Follow-up. Figure Legend:

4. Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes J Am Coll Cardiol. 2015;65(24):2591-2600. doi:10.1016/j.jacc.2015.04.029 Hospitalization and RM Effect on Unscheduled Visits Hospitalization data were reported as endpoint in 7 studies, comprising 5,372 patients. Pooled data from all 7 studies showed no significant reduction in the odds of hospitalization with RM (A). The impact of RM on unscheduled office visit burden was reported in 5 studies, and overall, RM showed a nonsignificant trend toward an increase in unscheduled visits (B). Abbreviations as in Figures 1 and 2. Figure Legend:

5. Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes J Am Coll Cardiol. 2015;65(24):2591-2600. doi:10.1016/j.jacc.2015.04.029 Effect of RM on ICD Shocks The incidence of patients receiving 1 or more ICD shock was reported in 4 studies. The odds of receiving any ICD shock were similar in RM and IO patients. Abbreviations as in Figures 1 and 2. Figure Legend: