BackgroundRemote monitoring (RM) of pacemakers and implantable cardioverter‐defibrillators (ICDs) is a Class 1, Level of Evidence A recommendation because of its multitude of clinical benefits. However, RM adherence rates are suboptimal, precluding patients from achieving these benefits. There is a need for direct‐to‐patient efforts to improve adherence.MethodsIn this national randomized, controlled trial conducted in the Veterans Health Administration (VHA), 2120 patients with a pacemaker or ICD who had not sent an RM transmission for ≥1 year (and usually ≥3 years) while under VHA care for their device were randomly assigned to be mailed a postcard (n = 1076) or a detailed letter (n = 1044). The postcard described what RM does and its key benefits (reduced mortality and fewer in‐person visits). The letter provided a similar message but included more details about RM benefits and the process. The primary outcome was an RM transmission sent within 90 days of mailing, and a secondary outcome was an RM transmission sent within 365 days.ResultsThe primary outcome was achieved in 121 (11.3%) in the postcard and 96 patients (9.2%) in the letter group (p = .12). The secondary outcome was achieved in 266 (24.7%) and 239 (22.9%), respectively (p = .32).ConclusionsThis randomized trial showed no significant difference in the proportion of chronically non‐adherent patients who sent an RM transmission after receiving a low‐cost postcard or a detailed, higher‐cost letter encouraging their participation in RM. However, as only a minority of patients responded to either, further work is needed to engage patients in the life‐saving benefits of RM.

中文翻译：

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用于对使用起搏器和植入式心律转复除颤器的退伍军人进行远程监测的信息信件或明信片：一项随机对照试验

背景起搏器和植入式心律转复除颤器 (ICD) 的远程监测 (RM) 因其具有众多临床益处而被列为 1 类 A 级证据推荐。然而，RM 依从率并不理想，导致患者无法获得这些益处。需要采取直接针对患者的努力来提高依从性。方法在退伍军人健康管理局 (VHA) 进行的这项全国随机对照试验中，2120 名使用起搏器或 ICD 且 1 年以上未发送 RM 传输的患者参加（通常≥3 年）在 VHA 护理期间，他们的设备被随机分配邮寄明信片（n= 1076）或一封详细的信件（n= 1044）。明信片描述了 RM 的作用及其主要优势（降低死亡率和减少亲自就诊）。该信函提供了类似的信息，但包含有关 RM 福利和流程的更多详细信息。主要结果是邮寄后 90 天内发送的 RM 传输，次要结果是 365 天内发送的 RM 传输。结果明信片中有 121 名患者 (11.3%) 达到了主要结果，明信片中有 96 名患者 (9.2%) 达到了主要结果。字母组（p=.12）。次要结局分别为 266 例（24.7%）和 239 例（22.9%）（p= .32)。结论这项随机试验显示，长期不依从的患者在收到低成本明信片或鼓励他们参与 RM 的详细、较高费用信件后发送 RM 传输的比例没有显着差异。然而，由于只有少数患者对其中任何一种有反应，因此需要进一步的工作来让患者参与 RM 的挽救生命的益处。