Remote monitoring in patients awaiting elective cardiac surgery is associated with improved clinical outcomes: a prospective service evaluation

Background

Rising elective cardiac surgery waiting times are associated with increased risk of clinical deterioration and unscheduled admissions. Remote patient monitoring (RPM) may offer earlier detection of deterioration, but its role during the pre-operative waiting period is not well established.

Methods

We conducted a prospective single centre service evaluation of a digital RPM pathway for adults listed for elective cardiac surgery between September 2022 and September 2023. Patients submitting at least one digital symptom questionnaire (activated group) were compared with those who did not (non-activated). Primary outcomes were preoperative mortality and unscheduled admissions requiring non elective intervention. Secondary outcomes included resternotomy, 1 year postoperative mortality, and length of stay.

Results

Of 1,164 patients, 799 (68.6%) were activated. Baseline characteristics were similar aside from higher hypertension and diabetes prevalence in the non-activated group. Pre-operative mortality was significantly lower in activated patients (0.6% vs 2.2%; RR 0.29, 95% CI 0.09–0.87; p=0.018). Unscheduled admissions were also reduced (2.1% vs 4.3%; RR 0.49, 95% CI 0.25–0.95; p=0.031). Kaplan–Meier analysis demonstrated early and sustained separation (log-rank p=0.012). Secondary outcomes were similar between groups.

In the propensity-matched cohort, activation remained associated with lower pre-operative mortality (0.7% vs 3.5%; RR 0.20; p=0.027) and fewer unscheduled admissions (2.0% vs 5.8%; RR 0.35; p=0.026).

Conclusion

Implementation of a structured pre-operative RPM pathway was feasible at scale and associated with significantly reduced pre-operative mortality and fewer unplanned admissions. These findings support RPM as a promising strategy to enhance safety and stability for patients awaiting elective cardiac surgery.