AIMS: In the IN-TIME trial, automatic daily implant-based multiparameter telemonitoring significantly improved clinical outcomes in patients with chronic systolic heart failure and implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D). We compared IN-TIME results for ICD and CRT-D subgroups. METHODS: Patients with LVEF ≤ 35%, NYHA class II/III, optimized drug treatment, no permanent atrial fibrillation, and a dual-chamber ICD (n = 274) or CRT-D (n = 390) were randomized 1:1 to telemonitoring or no telemonitoring for 12 months. Primary outcome measure was a composite clinical score, classified as worsened if the patient died or had heart failure-related hospitalization, worse NYHA class, or a worse self-reported overall condition. RESULTS: The prevalence of worsened score at study end was higher in CRT-D than ICD patients (26.4% vs. 18.2%; P = 0.014), as was mortality (7.4% vs. 4.1%; P = 0.069). With telemonitoring, odds ratios (OR) for worsened score and hazard ratios (HR) for mortality were similar in the ICD [OR = 0.55 (P = 0.058), HR = 0.39 (P = 0.17)] and CRT-D [OR = 0.68 (P = 0.10), HR = 0.35 (P = 0.018)] subgroups (insignificant interaction, P = 0.58-0.91). CONCLUSION: Daily multiparameter telemonitoring has a potential to reduce clinical endpoints in patients with chronic systolic heart failure both in ICD and CRT-D subgroups. The absolute benefit seems to be higher in higher-risk populations with worse prognosis.

2 Department of Medicine Cardiology Angiology and Intensive Care Medicine Universitätsklinikum Schleswig Holstein Lübeck Germany

Arrhythmia and Invasive Electrophysiology Section Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany

Center for Clinical Research Biotronik SE and Co KG Berlin Germany

Clinic for Cardiology and Angiology Hannover Medical School Hannover Germany

Clinic for Cardiology and Internistic Intensive Care Medicine Bielefeld Clinical Center Bielefeld Germany

Department of Cardiology and Internistic Intensive Care Medicine Munich State Hospital Bogenhausen Munich Germany

Department of Cardiology Hospital Munich Thalkirchen Peter Osypka Heart Center Munich Germany

Department of Cardiology Sana Kliniken Ostholstein Klinik Oldenburg Oldenburg Germany

Department of Cardiology University Hospital Gentofte Hellerup Denmark

Department of Clinical Medicine Århus University Åarhus Denmark

Department of Electrophysiology University of Leipzig Heart Center Leipzig Germany

Department of Internal Medicine 1 Cardiology Faculty of Medicine and Dentistry Olomouc Czech Republic

Department of Medicine 1 Cardiology Klinikum Großhadern Munich Germany

Division of Cardiology Vascular Medicine Pneumology and Intensive Care Medicine HELIOS Klinikum Pirna GmbH Pirna Germany

Medical Center for Cardiology Munich Germany

Na Homolce Prague Czech Republic

Otto von Guericke University School of Medicine Magdeburg Germany

Sydney Adventist Hospital Sydney Australia

University Hospital Bonn Bonn Germany

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Arrhythmia monitoring and outcome after myocardial infarction (BIO|GUARD-MI): a randomized trial