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Supplementary AppendixThis appendix has been provided by the authors to give readers additional information about their work.Supplement to: Piccini JP, Mittal S, Snell J, Prillinger JB, Dalal N, Varma N. Impact of Remote Monitoring on Clinical Events and associated Healthcare Utilization: A Nationwide Assessment. Supplementary Appendix: Table of ContentsTablesTable S1. MarketScan Commercial Claims and Encounters Database CodesTable S2. Baseline characteristics broken down by device typeTable S3. Cardiovascular hospitalization broken down by device typeFiguresFigure S1. Longitudinal follow-up intervals for all patientsFigure S2. All-cause hospitalization according to remote monitoring use, all device typesFigure S3. Forest Plot of the Primary Outcome in Prespecified SubgroupsFigure S4. Cardiovascular hospitalization according to remote monitoring use all device types.Figure S5. Heart failure hospitalization according to remote monitoring use in patients with prior diagnosis of heart failure, all device typesFigure S6. Stroke-related hospitalization according to remote monitoring use in patients with prior diagnosis of atrial fibrillation, all device types Table S1. MarketScan Commercial Claims and Encounters Database CodesICD-9 Codes used for Patient CharacterizationPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5RdWFuPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 1,2ComorbidityCodePrior Myocardial Infarction410.x-414.x,429.2,V45.81Heart Failure398.91,402.01,402.11,402.91,404.01,404.03,404.11,404.13,404.91, 404.93,425.4-425.9,428.xPeripheral Heart Disease093.0,437.3,440.x,441.x,443.1-443.9,447.1,557.1,557.9,V43.4Cerebrovascular Disease362.34,430.x-438.xDementia290.x,331.0Chronic Pulmonary Disease416.8,416.9,490.x-505.x,506.4,508.1,508.8Rheumatic Disease446.5,710.0-710.4,714.0-714.2,714.8,725.xPeptic Ulcer Disease531.x-534.xMild Liver Disease070.22,070.23,070.32,070.33,070.44,070.54,070.6,070.9,570.x,571.x,573.3,573.4,573.8,573.9,V42.7Diabetes Without Chronic Complication250.0x-250.3x,250.8x,250.9xDiabetes With Chronic Complication250.4x-250.7xHemiplegia / Paraplegia334.1,342.x,343.x,344.0-344.6,344.9Chronic Kidney Disease403.01,403.11,403.91,404.02,404.03,404.12,404.13,404.92,404.93,582.x,583.0-583.7,585.x,586.x,588.0,V42.0,V45.1,V56.xCancer140.x-172.x,174.x-193.x,194.x,195.0-195.8,195.0x-195.8xLiver Disease456.0-456.2,572.2-572.8Tumor196.x-199.xAIDS / HIV 042.-044.CPT Device Implant CodesDevice TypeCodePacemaker33206, 33207, 33212, 33227, C1786, C2620, 33208, 33213, 33228, 33214, C1785, C2619, 3780, 37.8, 00530, 71090, 3781, 3782, 3785, 3786, 3787, 3789, 33222, 33233, 33236, 33237ICD00534, 33241, 33223, 33249, 3794, 3796, 3798, 33240, C1722, 33230, C1721, 33263, 33262CRT0050, 0053, 33229, C2621, 33221, 93612, 33264, 0051, 0054, 33231, C1882, G0448, 33224, 33225, 0052, C1900Table S2. Baseline characteristics broken down by device typePACEMAKER PATIENTS?RMNo RMN15,571 38,949 Follow-up, months, mean (SD)20.8 ± 11.0 18.8 ± 12.2 Age, years, mean (SD)73.5 ± 12.1 75.3 ± 12.3 Sex, Male (%)56.7%54.7%Implant to first clinic visit, days, median (Q1,Q3)63.0 [44.0, 99.0] 63.0 [44.0, 98.0] Implant to first remote follow-up, days, median (Q1,Q3)64.0 [44.0, 99.0] na Charlson Comorbidity Index, mean (SD)2.7 ± 2.43.0 ± 2.7Heart Failure, %28.6%32.4%Atrial Fibrillation, %48.7%50.0%VT/VF, %7.2%6.2%Coronary artery disease, %55.0%57.5%Prior myocardial Infarction, %10.8%11.8%Hypertension, %80.2%81.7%Stroke, TIA, %15.6%18.2%Diabetes, %32.2%34.1%Valvular Heart Disease, %40.9%42.3%Cerebrovascular Disease, %32.8%35.9%Peripheral Heart Disease, %25.0%27.9%Chronic Pulmonary Disease, %31.2%32.7%Chronic Kidney Disease, %12.9%15.2%Rheumatic Disease, %4.4%4.7%Peptic Ulcer Disease, %2.6%2.9%Liver Disease, %5.5%5.8%Hypothyroidism, %20.4%21.5%Cancer, %17.7%18.8%Dementia, %3.3%4.9%Depression, %9.5%10.6%*The remote monitoring group includes patients with in-person clinic follow-up and remote monitoring. The No RM group includes patients with in-person clinic follow-up only. ICD PATIENTS?RMNo RMN 13,761 14,055 Follow-up, months, mean (SD)22.4 ± 11.3 17.0 ± 11.8 Age, years, mean (SD)65.8 ± 12.5 66.1 ± 13.2Sex, Male (%)74.7%74.5%Implant to first clinic visit, days, median (Q1,Q3)66.0 [44.0, 101.0] 65.0 [44.0, 100.0] Implant to first remote follow-up, days, median (Q1,Q3)67.0 [45.0, 101.0] na Charlson Comorbidity Index, mean (SD)3.2 ± 2.43.6 ± 2.6Heart Failure, %63.1%66.3%Atrial Fibrillation, %35.4%37.0%VT/VF, %39.5%36.0%Coronary artery disease, %76.0%78.4%Prior myocardial Infarction, %28.8%31.0%Hypertension, %73.4%77.7%Stroke, TIA, %10.8%12.6%Diabetes, %38.3%41.8%Valvular Heart Disease, %40.9%43.2%Cerebrovascular Disease, %23.8%27.8%Peripheral Heart Disease, %23.0%26.8%Chronic Pulmonary Disease, %31.5%36.5%Chronic Kidney Disease, %14.1%17.9%Rheumatic Disease, %3.2%3.5%Peptic Ulcer Disease, %2.1%2.3%Liver Disease, %5.5%6.6%Hypothyroidism, %14.2%15.2%Cancer, %14.4%14.9%Dementia, %1.3%1.9%Depression, %8.6%10.0%*The remote monitoring group includes patients with in-person clinic follow-up and remote monitoring. The No RM group includes patients with in-person clinic follow-up only. CRT-D PATIENTS?RMNo RMN 4,630 4,495 Follow-up, months, mean (SD)20.2 ± 11.1 14.9 ± 11.0 Age, years, mean (SD)68.5 ± 11.5 68.4 ± 12.2 Sex, Male (%)72.6%72.9%Implant to first clinic visit, days, median (Q1,Q3)64.0 [43.0, 100.0] 65.0 [44.0, 99.0] Implant to first remote follow-up, days, median (Q1,Q3)64.0 [43.0, 100.0] na Charlson Comorbidity Index, mean (SD)3.7 ± 2.54.0 ± 2.6Heart Failure, %81.2%84.2%Atrial Fibrillation, %42.6%45.7%VT/VF, %37.5%35.0%Coronary artery disease, %78.2%80.0%Prior myocardial Infarction, %24.0%26.8%Hypertension, %78.4%83.2%Stroke, TIA, %11.6%13.8%Diabetes, %43.1%46.8%Valvular Heart Disease, %48.7%50.9%Cerebrovascular Disease, %25.1%28.3%Peripheral Heart Disease, %25.5%28.2%Chronic Pulmonary Disease, %38.1%42.1%Chronic Kidney Disease, %18.7%21.5%Rheumatic Disease, %3.6%3.9%Peptic Ulcer Disease, %2.0%2.4%Liver Disease, %6.1%7.1%Hypothyroidism, %19.3%19.1%Cancer, %15.8%16.8%Dementia, %1.5%2.0%Depression, %10.1%12.0%*The remote monitoring group includes patients with in-person clinic follow-up and remote monitoring. The No RM group includes patients with in-person clinic follow-up only. CRT-P PATIENTS?RMNo RMN 297 808 Follow-up, months, mean (SD)15.5 ± 8.9 16.9 ± 11.5 Age, years, mean (SD)73.2 ± 12.5 73.5 ± 12.7Sex, Male (%)59.9%54.8%Implant to first clinic visit, days, median (Q1,Q3)57.0 [42.0, 100.0] 56.0 [43.0, 96.2] Implant to first remote follow-up, days, median (Q1,Q3)58.0 [42.0, 100.0] na Charlson Comorbidity Index, mean (SD)3.8 ± 2.73.3 ± 2.5Heart Failure, %62.0%59.0%Atrial Fibrillation, %65.0%64.5%VT/VF, %12.1%10.6%Coronary artery disease, %63.0%63.6%Prior myocardial Infarction, %14.1%12.9%Hypertension, %86.2%83.4%Stroke, TIA, %13.5%14.2%Diabetes, %37.7%35.9%Valvular Heart Disease, %53.9%47.5%Cerebrovascular Disease, %28.3%28.5%Peripheral Heart Disease, %26.9%28.3%Chronic Pulmonary Disease, %44.1%38.7%Chronic Kidney Disease, %20.9%18.7%Rheumatic Disease, %5.7%3.6%Peptic Ulcer Disease, %3.4%2.1%Liver Disease, %10.1%6.8%Hypothyroidism, %22.6%22.8%Cancer, %19.2%17.1%Dementia, %2.4%4.0%Depression, %13.1%13.4%*The remote monitoring group includes patients with in-person clinic follow-up and remote monitoring. The No RM group includes patients with in-person clinic follow-up only. Table S3. Rate (per 1,000 pt-year) and propensity adjusted hazard of CV hospitalizationALLRMNo-RMp-valueAdjusted HR (95% CI)Adjusted p-valueALL (N=92,566, 37% RM)72.9871.9573.61<0.0010.85 (0.82-0.88)<0.001PM (N=54,520, 29% RM)55.7351.5257.50<0.0010.86 (0.82-0.91)<0.001ICD (N=27,816, 49% RM)98.7389.67108.30<0.0010.73 (0.69-0.77)<0.001CRT-P (N=1,105, 27% RM)63.5042.7171.66<0.0010.69 (0.49-0.95)0.024CRT-D (N=9,125, 51% RM)101.4691.53112.52<0.0010.68 (0.62-0.75)<0.001CV hospitalization payments (per 1,000 pt-year)ALLRMNo-RMp-valueALL$1,756,658$1,656,493$1,818,702<0.001PM$1,093,524$982,721$1,140,048<0.001ICD$2,563,109$2,109,007$3,043,128<0.001CRT-P$1,583,791$699,078$1,931,167<0.001CRT-D$3,396,837$2,700,353$4,172,241<0.001Mean LOS per CV hospitalization (days)ALLRMNo-RMp-valueALL4.84.45.1<0.001PM4.44.04.5<0.001ICD5.14.45.7<0.001CRT-P4.83.94.90.196CRT-D5.75.36.0<0.001Figure S1. Longitudinal follow-up intervals for all patients Implant to First Clinic Visit0132715RMNo RM444410063 Days64 Days98(median, interquartile range)RMNo RM444410063 Days64 Days98(median, interquartile range)Follow-up Intervals8096253206115(months)RMNo RM(months)RMNo RMFigure S2. All-cause hospitalization according to remote monitoring use, all device types238125229870No RMRM00No RMRM5114925516255Mean LOS, daysRM: 5.3 (9.6)No RM: 8.1 (15.7) p < 0.00100Mean LOS, daysRM: 5.3 (9.6)No RM: 8.1 (15.7) p < 0.0011085850630555HR: 0.8295% CI: 0.80 – 0.84p-value: < 0.00100HR: 0.8295% CI: 0.80 – 0.84p-value: < 0.0011085850220980All device types00All device types-19907251659255Cumulative Percentage with EventCumulative Percentage with Event397192567310N = 92,56600N = 92,566Figure S3. Forest Plot of the Primary Outcome in Prespecified SubgroupsFigure S4. Cardiovascular hospitalization according to remote monitoring use all device types.3981450652203N = 92,56600N = 92,5662162175601345All device types00All device types21627521010920HR: 0.8595% CI: 0.82 – 0.88p-value: < 0.00100HR: 0.8595% CI: 0.82 – 0.88p-value: < 0.001Figure S5. Heart failure hospitalization according to remote monitoring use in patients with prior diagnosis of heart failure, all device types4855210918845Mean LOS, daysRM: 5.0 (8.0)No RM: 7.5 (12.5) p < 0.00100Mean LOS, daysRM: 5.0 (8.0)No RM: 7.5 (12.5) p < 0.001-22669501959610Cumulative Percentage with EventCumulative Percentage with Event771525575945All device types00All device types771525985520HR: 0.7695% CI: 0.71 – 0.81p-value: < 0.00100HR: 0.7695% CI: 0.71 – 0.81p-value: < 0.0013657600422275N = 43,28000N = 43,280-114300204470No RMRM00No RMRMFigure S6. Stroke-related hospitalization according to remote monitoring use in patients with prior diagnosis of atrial fibrillation, all device types4845685928370Mean LOS, daysRM: 3.8 (13.2)No RM: 3.9 (7.9) p = 0.94600Mean LOS, daysRM: 3.8 (13.2)No RM: 3.9 (7.9) p = 0.9463721100635635N = 41,85000N = 41,8508350251198880HR: 0.7895% CI: 0.67 – 0.91p-value: = 0.00100HR: 0.7895% CI: 0.67 – 0.91p-value: = 0.001835025789305All device types00All device types9525393065No RMRM00No RMRM References ADDIN EN.REFLIST 1.Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130-9.2.Birman-Deych E, Waterman AD, Yan Y, Nilasena DS, Radford MJ, Gage BF. Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors. Med Care 2005;43:480-5. ................
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