Remote Patient Management of CIEDs - Brady Devices

NCT ID: NCT03636230

Last Updated: 2025-02-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

848 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-15

Study Completion Date

2025-06-30

Brief Summary

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While remote monitoring (RM) technology is currently available and has permitted surveillance and device assessment from any patient location, the use has been inconsistent in Canada, where only 8500 out of a potential 120 000 patients with cardiac implantable electronic devices (CIEDs) are enrolled in this program. This technology is in widespread use worldwide for all CIEDs but in Canada, it is utilized primarily for implantable defibrillators, but not pacemakers. Whereas most of the trials were designed to evaluate the efficacy of RM in implantable cardioverter defibrillator (ICD) patients, in the pacemaker (PM) population, there has been work performed already to demonstrate an increase in detection of frequency of adverse clinical events and a reduction in reaction time to those events by RM. Based on all the available literature, it appears that RM benefits both patients and healthcare systems. Overall, studies have demonstrated that RM can be used safely in all device patient-populations, with the exception of pacemaker-dependent patients.

There have been no studies that have evaluated RM only follow up, nor have there been any studies evaluating pacemaker-dependent patients. This study that will safely assess the use of RM only, with in-clinic visits when necessary, that uses the patient-centered electronic platform developed by the Cardiac Arrhythmia Network of Canada (CANet) to perform PM follow up safely, in a more cost-effective manner.

Detailed Description

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This is a Canadian multicenter randomized controlled trial to assess remote patient management. Patients will be randomized in a 1:1 fashion, stratified by pacemaker dependence and by center to either remote patient management of standard of care.

Remote patient management (intervention group):

* Patients will be followed by remote monitoring only. Transmissions will occur at six monthly intervals, with no in-clinic visits. If there is an actionable event on the remote transmission, patients will be seen at their closest community device clinic. The proposed intervention would eliminate any routine visits.
* Newly implanted pacemaker patients will be seen after the initial implant at the hub site, within 48 hours and then within 3 months to optimize programming for subsequent RM visits. Thereafter, all follow-up will occur through remote monitoring every six months. Unscheduled remote transmissions may also occur. Using a combination of remote monitoring, and novel technology, VIRTUES, patients will be managed outside of the clinic.
* Patients will be provided with real-time knowledge of success of their remote transmission and the status of the remote through a web-based portal called VIRTUES.
* Virtual patient record - all patient information in the intervention arm will be contained within an information cloud that will be accessible by patients; access to their own data may be granted by the patient themselves to permit delivery of care remotely, and to permit after hours follow up to be performed by the on call personnel.

Standard of care (comparison group):

The standard arm will be required to have in-clinic visits at yearly intervals. These patients would not have access to the virtual patient cloud or to remote monitoring.

Pacemaker programming: All patients in both arms will undergo programming as per the ASSERT II protocol (previously published) to optimize pacemaker parameters and detection of atrial and ventricular high rate episodes.

Conditions

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Pacemaker

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Open label, 1:1 randomized trial, stratified by site and pacemaker dependence
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Remote Patient Management

Remote monitoring only

Group Type ACTIVE_COMPARATOR

Remote Monitoring

Intervention Type DEVICE

Remote Monitoring only + VIRTUES

Standard of Care

In-clinic visits

Group Type PLACEBO_COMPARATOR

Standard of care

Intervention Type OTHER

In-Clinic visits only

Interventions

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Remote Monitoring

Remote Monitoring only + VIRTUES

Intervention Type DEVICE

Standard of care

In-Clinic visits only

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with a Medtronic or Abbott pacemaker capable of remote monitoring.
* Able to provide consent.
* Age \>/= 18 years

Exclusion Criteria

* No access to a family physician or general practioner
* Participation in the RPM CIED pilot study
* Unreliable automated capture verification function by the device in pacemaker-dependent patients
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cardiac Arrhythmia Network of Canada

OTHER

Sponsor Role collaborator

Medtronic

INDUSTRY

Sponsor Role collaborator

Abbott

INDUSTRY

Sponsor Role collaborator

Ratika Parkash

OTHER

Sponsor Role lead

Responsible Party

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Ratika Parkash

Staff Cardiologist Electrophysiologist

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Ratika Parkash, MD FRCPC

Role: PRINCIPAL_INVESTIGATOR

Nova Scotia Health Authority

Locations

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Foothills Hospital

Calgary, Alberta, Canada

Site Status RECRUITING

Victoria Cardiac Arrhythmia Trials

Victoria, British Columbia, Canada

Site Status RECRUITING

Memorial University of Newfoundland Hospital

St. John's, Newfoundland and Labrador, Canada

Site Status RECRUITING

QEII Health Sciences Center

Halifax, Nova Scotia, Canada

Site Status RECRUITING

St. Mary's General Hospital

Kitchener, Ontario, Canada

Site Status RECRUITING

London Health Sciences Centre

London, Ontario, Canada

Site Status RECRUITING

Southlake Regional Health Centre

Newmarket, Ontario, Canada

Site Status RECRUITING

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status RECRUITING

Hopital Sacre Coeur

Montreal, Quebec, Canada

Site Status RECRUITING

Hopital Laval

Québec, Quebec, Canada

Site Status RECRUITING

Centre Hospitalier Universitaire du Sherbrooke

Sherbrooke, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Ratika Parkash, MD FRCPC

Role: CONTACT

902 473 4474

Patricia Theoret

Role: CONTACT

613-866-0698

Facility Contacts

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Marcello Tonelli

Role: primary

May Woodburn

Role: primary

Ashley Hunt

Role: primary

Ashley Hilchie

Role: primary

902 717-6920

Mary Radyk

Role: primary

Cheryl Litchfield

Role: primary

Brigitte Boaretto

Role: primary

Jean-Claude Tardif

Role: primary

Ann Langlois

Role: primary

Paule Banville

Role: primary

William Fraser

Role: primary

Other Identifiers

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RP-006

Identifier Type: -

Identifier Source: org_study_id

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