Hypertension patients on remote monitoring had lower mortality, fewer hospitalizations

Remote monitoring was associated with an increase in outpatient visits, which was likely due to reimbursement requirements, according to the authors of the retrospective study of Medicare patients with hypertension.

Remote monitoring was associated with lower risk of death or hospitalization in older patients with hypertension, a study found.

The retrospective cohort study included Medicare beneficiaries ages 65 years and older who had an outpatient hypertension diagnosis between July 2018 and September 2020: 16,339 who used a remote patient monitoring system (based on coding data) and 63,333 controls who did not. The primary goal was to evaluate relationships between use of remote patient monitoring and all-cause mortality, hospitalizations, and ED and outpatient visits. Results were published by the Journal of General Internal Medicine on Nov. 16.

After 180 days of follow-up, the mortality rate was 2.9% in the remote monitoring patients compared to 4.3% in nonusers (hazard ratio [HR], 0.66; 95% CI, 0.60 to 0.74). Patients on monitoring also had lower rates of hospitalization for any cause (HR, 0.78; 95% CI, 0.75 to 0.82) or cardiovascular causes (HR, 0.79; 95% CI, 0.73 to 0.87). There was no significant association between monitoring and ED use, but patients on monitoring were more likely to have outpatient visits (HR, 1.10; 95% CI, 1.08 to 1.11), driven by an increase in visits related to cardiovascular causes (HR, 2.17; 95% CI, 2.13 to 2.19).

Based on the findings, the study authors concluded that remote monitoring for hypertension was associated with substantial reductions in the hazards of mortality and hospitalization. “Our finding of higher outpatient visits among RPM [remote patient monitoring] users is likely a consequence of regular follow-up built into the RPM modality for monthly reimbursement,” they said.

The study was limited by the risk of unmeasured confounding, including that patients on monitoring could have had better access to health care “and the lower mortality risk and higher outpatient visits could be an artifact of that access,” said the authors. Still, they suggested that the findings should be considered, along with additional research, in decisions about expanding reimbursement for remote monitoring. “Continuous evaluation of effectiveness of RPM services for chronic conditions with longer follow-up is warranted along with its potential cost-effectiveness and budget impact for public and private health systems,” they said.