Cost-Effectiveness Data on Insertable Cardiac Monitors

Lead author, Dr. Klaus Witte, Senior Lecturer and Consultant Cardiologist, University of Leeds and Leeds General Infirmary, discusses findings from a new economic study titled “Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke”.  Results were recently published in the Journal of Comparative Effectiveness Research.

Klaus Witte is a Senior Lecturer and Consultant Cardiologist in the Leeds Institute of Cardiovascular and Metabolic Medicine at the University of Leeds. He has his own group investigating the relationship between pacemaker therapy and heart failure and also is the Head of the Department of Clinical and Population Science in the Leeds Institute of Cardiovascular and Metabolic Medicine with line management responsibilities for over 40 investigators, fellows and technical staff. His research interests include vitamin D in CHF, and he was principle investigator of VINDICATE, the largest study of vitamin D supplementation in CHF patients (Medical Research Council) showing improved LV function following one year of vitamin D. He was co-investigator on the recently published REM-HF study (Eur Heart J) describing a neutral effect of remote monitoring in CHF patients (British Heart Foundation). He is the only cardiologist in the UK to have held an NIHR (UK) clinician scientist award, in his case for the OPT-pace project, which, with 1800 patients enrolled is the largest ever prospective study to collect information on the relationship between pacemakers and heart failure (EHRA late breaking clinical trials 2019). He has recently published the results of the REDUCE-FMR study describing the potential of a transvenous coronary sinus-based approach to reducing mitral regurgitation in patients with heart failure and reduced ejection fraction (JACC-HF) He has long questioned standard teaching around heart rate and exercise capacity in heart failure (JACC 2016). His group described a reproducible non-invasive technique to measure contractility and plot the force-frequency relationship. Peak contractility in heart failure occurs at a lower heart rate than in health. This finding and two randomised double-blind clinical trials describing the benefit on exercise capacity of programming pacemakers using patients’ force frequency relationship information (JACC-HF 2018, Circulation 2020) have changed the way we view heart rate in heart failure. His interests extend to health economics, specifically the assessment of cost effectiveness of device therapy, where the upfront costs of devices in a population are particularly challenging for payers.

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