AIMS Studies of remote monitoring (RM) in heart failure (HF) speculate that patients with atrial fibrillation (AF) derive the greatest benefit. We compared the impact of RM vs. usual care on clinical outcomes for patients with and without AF enrolled in the Remote Management of Heart Failure Using Implanted Electronic Devices (REM-HF) trial. METHODS AND RESULTS Rhythm status was available for 1561 patients (94.6%). Three categories were defined based on total AF duration during the first year of follow-up: (i) no AF (n = 1211, 77.6%), (ii) paroxysmal AF (≥6 min to ≤7 days; n = 92, 5.9%), and (iii) persistent/permanent AF (>7 days; n = 258, 16.5%). Clinical activity, mortality, and hospitalisation rates were compared between treatment strategies for each group. RM resulted in a greater volume of clinical activity in patients with any AF, vs. no AF, with the highest per-patient intervention required for patients with persistent/permanent AF. During 2.8 ± 0.8 years of follow-up, RM was not associated with a reduction in all-cause or cardiovascular mortality for patients with AF. However, in patients with persistent/permanent AF, RM conferred an increased risk of recurrent cardiovascular [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.06-1.85, P = 0.018] and HF-related (HR 2.05, 95% CI 1.14-3.69, P = 0.016) hospitalisations. CONCLUSION In patients with HF and a cardiac implanted electronic device, RM generated greater clinical activity for patients with AF, with no associated reduction in mortality, and conversely, greater risk of cardiovascular hospitalisation amongst patients with persistent/permanent AF. RM strategies may vary in their capability to guide HF management; modified approaches may be needed to improve outcomes for HF patients with AF.

中文翻译：

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远程监测对心力衰竭和心房颤动患者临床结局的影响：REM-HF试验的结果。

AIMS对心力衰竭（HF）进行远程监测（RM）的研究推测，房颤（AF）患者可获益最大。我们比较了使用植入式电子设备（REM-HF）进行的心衰远程管理研究中，无论有无AF的患者，RM和常规护理对临床结局的影响。方法和结果1561名患者（94.6％）的心律状态可用。根据随访第一年的总房颤持续时间定义了三类：（i）无房颤（n = 1211，77.6％），（ii）阵发性房颤（≥6min至≤7天； n = 92， 5.9％），以及（iii）持续性/永久性AF（> 7天； n = 258，16.5％）。比较各组治疗策略的临床活动，死亡率和住院率。RM导致任何房颤患者的临床活动量增加。无房颤，持续性/永久性房颤患者需要最高的每位患者干预。在2.8±0.8年的随访中，房颤患者的RM与全因或心血管疾病死亡率的降低无关。然而，对于患有持续性/永久性房颤的患者，RM会增加复发性心血管疾病的风险[危险比（HR）1.40，95％置信区间（CI）1.06-1.85，P = 0.018]和HF相关性（HR 2.05，95） ％CI 1.14-3.69，P = 0.016）。结论在有心律衰竭和心脏植入式电子设备的患者中，RM为房颤患者带来了更大的临床活动，并且没有相关的死亡率降低，反之，对于持续性/永久性房颤患者，心血管疾病住院的风险更大。RM策略指导HF管理的能力可能有所不同；