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Koehler F, Hiddemann M, Koehler M, Koehler K, Spethmann S, Kaas T, Zippel-Schultz B, Helms TM. [Telemedical care concepts for heart failure: status and future]. Herz 2024:10.1007/s00059-024-05266-x. [PMID: 39191939 DOI: 10.1007/s00059-024-05266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/29/2024]
Abstract
Telemedical care concepts provide opportunities to improve the care of patients with chronic heart failure (CHF). The current state of telemedical technologies enables the effective monitoring of the disease. Germany is one of the first European countries with an entitlement to telemedical supporting care for CHF patients. The decision of the German Federal Joint Committee in 2020 to introduce telemedical supporting care for CHF patients marks a milestone. For the first time, a digital care procedure was included in the benefits catalogue of the statutory health insurance funds due to its proven benefits in terms of morbidity and mortality. Privately insured CHF patients have been entitled to these benefits since January 2024. Future developments, particularly with respect to artificial intelligence procedures in telemedicine, are promising but require more evidence. Further research, technological innovation and supportive policy frameworks are needed to realize the full potential of these approaches. Continued collaboration between healthcare professionals, technology developers and policy makers will be crucial in sustainably improving the care of heart failure patients with telemedicine.
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Affiliation(s)
- F Koehler
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Charité-Universitätsmedizin Berlin, Medizinische Fakultät der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Hiddemann
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Charitéplatz 1, 10117, Berlin, Deutschland
- Charité-Universitätsmedizin Berlin, Medizinische Fakultät der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Koehler
- Lehrstuhl und Poliklinik für Prävention, Rehabilitation und Sportmedizin, Technische Universität München, Klinikum rechts der Isar, 80992, München, Deutschland
- Notfallambulanz mit Infektionsambulanz der 2. Medizinischen Abteilung in der Klinik Donaustadt, Donauspital Wien, Langobardenstraße 122, 1220, Wien, Österreich
| | - K Koehler
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Charitéplatz 1, 10117, Berlin, Deutschland
- Charité-Universitätsmedizin Berlin, Medizinische Fakultät der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - S Spethmann
- Charité-Universitätsmedizin Berlin, Medizinische Fakultät der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - T Kaas
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Charitéplatz 1, 10117, Berlin, Deutschland
- Charité-Universitätsmedizin Berlin, Medizinische Fakultät der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - B Zippel-Schultz
- Deutsche Stiftung für chronisch Kranke, Berlin, Fürth, Deutschland
| | - T M Helms
- Deutsche Stiftung für chronisch Kranke, Berlin, Fürth, Deutschland
- Peri Cor Arbeitsgruppe Kardiologie/Ass. UCSF, Hamburg, Deutschland
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2
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Guichard JL, Bonno EL, Nassif ME, Khumri TM, Miranda D, Jonsson O, Shah H, Alexy T, Macaluso GP, Sur J, Hickey G, McCann P, Cowger JA, Badiye A, Old WD, Raza Y, Masha L, Kunavarapu CR, Bennett M, Sharif F, Kiernan M, Mullens W, Chaparro SV, Mahr C, Amin RR, Stevenson LW, Hiivala NJ, Owens MM, Sauerland A, Forouzan O, Klein L. Seated Pulmonary Artery Pressure Monitoring in Patients With Heart Failure: Results of the PROACTIVE-HF Trial. JACC. HEART FAILURE 2024:S2213-1779(24)00485-2. [PMID: 39152983 DOI: 10.1016/j.jchf.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Monitoring supine pulmonary artery pressures to guide heart failure (HF) management has reduced HF hospitalizations in select patients. OBJECTIVES The purpose of this study was to evaluate the effect of managing seated mean pulmonary artery pressure (mPAP) with the Cordella Pulmonary Artery sensor on outcomes in patients with HF. METHODS Following GUIDE-HF (Hemodynamic-GUIDEd Management of Heart Failure Trial), with U.S. Food and Drug Administration input, PROACTIVE-HF (A Prospective, Multi-Center, Open Label, Single Arm Clinical Trial Evaluating the Safety and Efficacy of the Cordella Pulmonary Artery Sensor System in NYHA Class III Heart Failure Patients trial) was changed from a randomized to a single-arm, open label trial, conducted at 75 centers in the USA and Europe. Eligible patients had chronic HF with NYHA functional class III symptoms, irrespective of the ejection fraction, and recent HF hospitalization and/or elevated natriuretic peptides. The primary effectiveness endpoint at 6 months required the HF hospitalization or all-cause mortality rate to be lower than a performance goal of 0.43 events/patient, established from previous hemodynamic monitoring trials. Primary safety endpoints at 6 months were freedom from device- or system-related complications or pressure sensor failure. RESULTS Between February 7, 2020, and March 31, 2023, 456 patients were successfully implanted in modified intent-to-treat cohort. The 6-month event rate was 0.15 (95% CI: 0.12-0.20) which was significantly lower than performance goal (0.15 vs 0.43; P < 0.0001). Freedom from device- or system-related complications was 99.2% and freedom from sensor failure was 99.8% through 6 months. CONCLUSIONS Remote management of seated mPAP is safe and results in a low rate of HF hospitalizations and mortality. These results support the use of seated mPAP monitoring and extend the growing body of evidence that pulmonary artery pressure-guided management improves outcomes in heart failure. (Multi-Center, Open Label, Single Arm Clinical Trial Evaluating the Safety and Efficacy of the Cordella Pulmonary Artery Sensor System in NYHA Class III Heart Failure Patients trial [PROACTIVE-HF]; NCT04089059).
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Affiliation(s)
- Jason L Guichard
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Eric L Bonno
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Michael E Nassif
- Saint Luke's Mid-American Heart Institute, Kansas City, Missouri, USA
| | - Taiyeb M Khumri
- Saint Luke's Mid-American Heart Institute, Kansas City, Missouri, USA
| | - David Miranda
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Orvar Jonsson
- Department of Cardiology, Sanford Heart Hospital, Sioux Falls, South Dakota, USA
| | - Hirak Shah
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tamas Alexy
- Department of Cardiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Gregory P Macaluso
- Department of Cardiology, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - James Sur
- Department of Cardiology, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Gavin Hickey
- Department of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patrick McCann
- Department of Cardiology, Prisma Health, Columbia, South Carolina, USA
| | - Jennifer A Cowger
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Amit Badiye
- Department of Cardiology, Sentara Healthcare, Norfolk, Virginia, USA
| | - Wayne D Old
- Department of Cardiology, Sentara Healthcare, Norfolk, Virginia, USA
| | - Yasmin Raza
- Department of Cardiology, Northwestern, Chicago, Illinois, USA
| | - Luke Masha
- Department of Cardiology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Mosi Bennett
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Faisal Sharif
- Department of Cardiology, Galway University Hospital, Saolta Group, CURAM and University of Galway, Galway, Ireland
| | - Michael Kiernan
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Sandra V Chaparro
- Miami Cardiac and Vascular Institute, Division of Cardiology, Baptist Health South Florida, Miami, Florida, USA
| | - Claudius Mahr
- Institute for Advanced Cardiac Care, Medical City, Dallas, Texas, USA
| | - Rohit R Amin
- Department of Cardiology, Ascension Sacred Heart Hospital, Pensacola, Florida, USA
| | - Lynne Warner Stevenson
- Division of Cardiology, Section of Heart Failure and Cardiac Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Max M Owens
- Clinical Science, Endotronix Inc, Naperville, Illinois, USA
| | | | - Omid Forouzan
- Clinical Science, Endotronix Inc, Naperville, Illinois, USA
| | - Liviu Klein
- Advanced Heart Failure Comprehensive Care Center and Division of Cardiology, University of California San Francisco, San Francisco, California, USA.
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3
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Meerkin D, Perl L, Hasin T, Petriashvili S, Kurashvili L, Metreveli M, Ince H, Feickert S, Habib M, Caspi O, Jonas M, Amat-Santos IJ, Bayes-Genis A, Codina P, Koren O, Frydman S, Pachino RM, Anker SD, Abraham WT. Physician-directed patient self-management in heart failure using left atrial pressure: Interim insights from the VECTOR-HF I and IIa studies. Eur J Heart Fail 2024; 26:1814-1823. [PMID: 38899626 DOI: 10.1002/ejhf.3338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
AIMS Haemodynamic monitoring using implantable pressure sensors reduces the risk of heart failure (HF) hospitalizations. Patient self-management (PSM) of haemodynamics in HF has the potential to personalize treatment, increase adherence, and reduce the risk of worsening HF, while lowering clinicians' burden. METHODS AND RESULTS The VECTOR-HF I and IIa studies are prospective, single-arm, open-label clinical trials assessing safety, usability and performance of left atrial pressure (LAP)-guided HF management using PSM in New York Heart Association class II and III HF patients. Physician-prescribed LAP thresholds trigger patient self-adjustment of diuretics. Primary endpoints include the ability to perform LAP measurements and transmit data to the healthcare provider (HCP) interface and the patient guidance application, and safety outcomes. This is an interim analysis of 13 patients using the PSM approach. Over 12 months, no procedure- or device-related major adverse cardiovascular or neurological events were observed, and there were no failures to obtain measurements from the sensor and transmit the data to the HCP interface and the patient guidance application. Patient adherence was 91.4%. Using PSM, annualized HF hospitalization rate significantly decreased compared to a similar period prior to PSM utilization (0 admissions vs. 0.69 admissions over 11.84 months, p = 0.004). At 6 months, 6-min walk test distance and the Kansas City Cardiomyopathy Questionnaire overall summary score demonstrated significant improvement. CONCLUSIONS Interim findings suggest that PSM using a LAP monitoring system is feasible and safe. PSM is associated with high patient adherence, potentially improving HF patients' functional status, quality of life, and limiting HF hospitalizations.
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Affiliation(s)
- David Meerkin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Leor Perl
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | | | | | | | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
- Department of Cardiology, Rostock University, Medical Center, Rostock, Germany
| | - Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
- Department of Cardiology, Rostock University, Medical Center, Rostock, Germany
| | - Manhal Habib
- Department of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - Oren Caspi
- Department of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Antoni Bayes-Genis
- Department of Cardiology, Germans Trias University Hospital, CIBERCV, Badalona, Spain
| | - Pau Codina
- Department of Cardiology, Germans Trias University Hospital, CIBERCV, Badalona, Spain
| | - Oran Koren
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Division of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Stefan D Anker
- Department of Cardiology, Berlin Institute of Health Center for Regenerative Therapies, German Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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4
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Dauw J, Sokolski M. Do we need more tools or better tools to assess congestion? ESC Heart Fail 2024. [PMID: 38980992 DOI: 10.1002/ehf2.14969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Affiliation(s)
- Jeroen Dauw
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Mateusz Sokolski
- Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
- Centre for Heart Diseases, University Hospital, Wrocław, Poland
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5
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Efremov S, Zagatina A, Filippov A, Ryadinskiy M, Novikov M, Shmatov D. Left Ventricular Diastolic Dysfunction in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00435-X. [PMID: 39069379 DOI: 10.1053/j.jvca.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
Cardiac relaxation is a complex process that involves various interconnected characteristics and, along with contractile properties, determines stroke volume. Perioperative ischemia-reperfusion injury and left ventricular diastolic dysfunction (DD) are characterized by the left ventricle's inability to receive a sufficient blood volume under adequate preload. Baseline DD and perioperative DD have an impact on postoperative complications, length of hospital stay, and major clinical outcomes in a variety of cardiac pathologies. Several baseline and perioperative factors, such as age, female sex, hypertension, left ventricle hypertrophy, diabetes, and perioperative ischemia-reperfusion injury, contribute to the risk of DD. The recommended diagnostic criteria available in guidelines have not been validated in the perioperative settings and still need clarification. Timely diagnosis of DD might be crucial for effectively treating postoperative low cardiac output syndrome. This implies the need for an individualized approach to fluid infusion strategy, cardiac rate and rhythm control, identification of extrinsic causes, and administration of drugs with lusitropic effects. The purpose of this review is to consolidate scattered information on various aspects of diastolic dysfunction in cardiac surgery and provide readers with well-organized and clinically applicable information.
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Affiliation(s)
- Sergey Efremov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation.
| | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Alexey Filippov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Mikhail Ryadinskiy
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Maxim Novikov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Dmitry Shmatov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
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6
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Scacciavillani R, Koliastasis L, Doundoulakis I, Chiotis S, Kordalis A, Narducci ML, Kotoulas S, Pinnacchio G, Bencardino G, Perna F, Comerci G, Gatzoulis KA, Tsiachris D, Pelargonio G. Remote Monitoring of Cardiac Implantable Electronic Devices in Very Elderly Patients: Advantages and Specific Problems. J Cardiovasc Dev Dis 2024; 11:209. [PMID: 39057629 PMCID: PMC11277150 DOI: 10.3390/jcdd11070209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician-patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.
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Affiliation(s)
- Roberto Scacciavillani
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Sotirios Chiotis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
- Cardiology Unit, Cardiothoracic Department, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sotiris Kotoulas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gaetano Pinnacchio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluigi Bencardino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Francesco Perna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluca Comerci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gemma Pelargonio
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
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7
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Urban S, Szymański O, Grzesiak M, Tokarczyk W, Błaziak M, Jura M, Fułek M, Fułek K, Iwanek G, Gajewski P, Ponikowski P, Biegus J, Zymliński R. Effectiveness of remote pulmonary artery pressure estimating in heart failure: systematic review and meta-analysis. Sci Rep 2024; 14:12929. [PMID: 38839890 PMCID: PMC11153505 DOI: 10.1038/s41598-024-63742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
Heart failure (HF) poses a significant challenge, often leading to frequent hospitalizations and compromised quality of life. Continuous pulmonary artery pressure (PAP) monitoring offers a surrogate for congestion status in ambulatory HF care. This meta-analysis examines the efficacy of PAP monitoring devices (CardioMEMS and Chronicle) in preventing adverse outcomes in HF patients, addressing gaps in prior randomized controlled trials (RCTs). Five RCTs (2572 participants) were systematically reviewed. PAP monitoring significantly reduced HF-related hospitalizations (RR 0.72 [95% CI 0.6-0.87], p = 0.0006) and HF events (RR 0.86 [95% CI 0.75-0.99], p = 0.03), with no impact on all-cause or cardiovascular mortality. Subgroup analyses highlighted the significance of CardioMEMS and blinded studies. Meta-regression indicated a correlation between prolonged follow-up and increased reduction in HF hospitalizations. The risk of bias was generally high, with evidence certainty ranging from low to moderate. PAP monitoring devices exhibit promise in diminishing HF hospitalizations and events, especially in CardioMEMS and blinded studies. However, their influence on mortality remains inconclusive. Further research, considering diverse patient populations and intervention strategies with extended follow-up, is crucial for elucidating the optimal role of PAP monitoring in HF management.
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Affiliation(s)
- Szymon Urban
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Oskar Szymański
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wrocław, Poland
| | - Magdalena Grzesiak
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wrocław, Poland.
| | - Wojciech Tokarczyk
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wrocław, Poland
| | - Mikołaj Błaziak
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Maksym Jura
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wrocław, Poland
- Department of Physiology and Pathophysiology, Wroclaw Medical University, Wrocław, Poland
| | - Michał Fułek
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Fułek
- Department and Clinic of Otolaryngology, Head and Neck Surgery, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Gracjan Iwanek
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Gajewski
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Jan Biegus
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
| | - Robert Zymliński
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland
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8
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Manavi T, Zafar H, Sharif F. An Era of Digital Healthcare-A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management. SENSORS (BASEL, SWITZERLAND) 2024; 24:2546. [PMID: 38676163 PMCID: PMC11053658 DOI: 10.3390/s24082546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Heart failure (HF) is a multi-faceted, complex clinical syndrome characterized by significant morbidity, high mortality rate, reduced quality of life, and rapidly increasing healthcare costs. A larger proportion of these costs comprise both ambulatory and emergency department visits, as well as hospital admissions. Despite the methods used by telehealth (TH) to improve self-care and quality of life, patient outcomes remain poor. HF management is associated with numerous challenges, such as conflicting evidence from clinical trials, heterogeneity of TH devices, variability in patient inclusion and exclusion criteria, and discrepancies between healthcare systems. A growing body of evidence suggests there is an unmet need for increased individualization of in-hospital management, continuous remote monitoring of patients pre and post-hospital admission, and continuation of treatment post-discharge in order to reduce re-hospitalizations and improve long-term outcomes. This review summarizes the current state-of-the-art for HF and associated novel technologies and advancements in the most frequently used types of TH (implantable sensors), categorizing devices in their preclinical and clinical stage, bench-to-bedside implementation challenges, and future perspectives on remote HF management to improve long-term outcomes of HF patients. The Review also highlights recent advancements in non-invasive remote monitoring technologies demonstrated by a few pilot observational prospective cohort studies.
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Affiliation(s)
- Tejaswini Manavi
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Department of Cardiology, University Hospital Galway, H91 YR71 Galway, Ireland
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9
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Sharif F, Rosenkranz S, Bartunek J, Kempf T, Aßmus B, Mahon NG, Hiivala NJ, Mullens W. Twelve-month follow-up results from the SIRONA 2 clinical trial. ESC Heart Fail 2024; 11:1133-1143. [PMID: 38271076 DOI: 10.1002/ehf2.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/07/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
AIMS In the SIRONA 2 trial, the safety and efficacy of pulmonary artery (PA) pressure (PAP)-guided heart failure (HF) management using a novel PAP sensor were assessed at 30 and 90 days, respectively, and both endpoints were met. The current study examines the prespecified secondary endpoints of safety and accuracy of the PA sensor along with HF hospitalizations and mortality, HF symptoms, functional capacity, quality of life, and patient compliance through 12 months. METHODS AND RESULTS SIRONA 2 is a prospective, multi-centre, open-label, single-arm trial evaluating the Cordella™ PA Sensor System in 70 patients with New York Heart Association (NYHA) functional class III HF with a prior HF hospitalization and/or increase of N-terminal pro-brain natriuretic peptide within 12 months of enrolment. Sensor accuracy was assessed and compared with measurements obtained by standard right heart catheterization (RHC). Safety was defined as freedom from prespecified adverse events associated with use of the Cordella PA Sensor System and was assessed in all patients who entered the cath lab for PA sensor implant. HF hospitalizations and mortality, HF symptoms, functional capacity, quality of life, and patient compliance were also assessed. At 12 months, there was good agreement between the Cordella PA Sensor System and RHC, with the average difference for mean PAP being 2.9 ± 7.3 mmHg. The device safety profile was excellent with 98.4% freedom from device/system-related complications. There were no pressure sensor failures. HF hospitalizations and mortality were low with a rate of 0.33 event per patient year. Symptoms as assessed by NYHA (P < 0.0001) and functional capacity as measured by 6 min walk test (P = 0.02) were significantly improved. Patients' adherence to daily transmissions of PAP and vital signs measurements was 95%. CONCLUSIONS Long-term follow-up of the SIRONA 2 trial supports the safety and accuracy of the Cordella PA Sensor System in enabling comprehensive HF management in NYHA class III HF patients.
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Affiliation(s)
- Faisal Sharif
- Department of Cardiology, Galway University Hospital, Saolta Group, CURAM and University of Galway, Galway, Ireland
| | - Stephen Rosenkranz
- Clinic III for Internal Medicine, University of Cologne Heart Center and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Ziekenhuis Aalst, Aalst, Belgium
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Birgit Aßmus
- Department of Cardiology and Angiology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Niall G Mahon
- Department of Cardiovascular Medicine, Mater University Hospital and University College Dublin, Dublin, Ireland
| | | | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- University of Hasselt, Hasselt, Belgium
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10
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Mullens W, Rosenkranz S, Sharif F, Aßmus B, Mahon NG, Kempf T, Stevenson LW, Bartunek J. Feasibility of Continuous Noninvasive Pulmonary Artery Pressure Monitoring via the Cordella Implantable Pulmonary Artery Sensor. JACC. HEART FAILURE 2024; 12:785-788. [PMID: 38385936 DOI: 10.1016/j.jchf.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost-Limburg, Genk, Belgium; University Hasselt, Genk, Belgium
| | - Stephen Rosenkranz
- University of Cologne Heart Center, Cologne, Germany; Cologne Cardiovascular Research Center, Cologne, Germany
| | - Faisal Sharif
- Galway University Hospital, Galway, Ireland; University of Galway, Galway, Ireland
| | - Birgit Aßmus
- University Hospital Giessen, Giessen, Germany; Marburg GmbH, Giessen, Germany
| | - Niall G Mahon
- Mater University Hospital, Dublin, Ireland; University College Dublin, Dublin, Ireland
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11
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Gupta K, Mastoris I, Sauer AJ. Remote Monitoring Devices and Heart Failure. Heart Fail Clin 2024; 20:1-13. [PMID: 37953016 DOI: 10.1016/j.hfc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Remote patient monitoring (RPM) in patients with heart failure (HF) involves transmitting physiological data from devices to a health-care provider via a wireless connection with targeted interventions when values exceed the preset threshold. Devices used in telemonitoring range from weighing scales, blood pressure cuffs, and pulse oximeters to devices used to measure cardiac filling pressure and intrathoracic impedance using cardiac implantable electronic devices and wearables. Accordingly, RPM devices can potentially engage patients in their cardiovascular care and reduce the burden of HF in society.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
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12
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Clephas PRD, de Boer RA, Brugts JJ. Benefits of remote hemodynamic monitoring in heart failure. Trends Cardiovasc Med 2023:S1050-1738(23)00111-1. [PMID: 38109949 DOI: 10.1016/j.tcm.2023.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
Despite treatment advancements, HF mortality remains high, prompting interest in reducing HF-related hospitalizations through remote monitoring. These advances are necessary considering the rapidly rising prevalence and incidence of HF worldwide, presenting a burden on hospital resources. While traditional approaches have failed in predicting impending HF-related hospitalizations, remote hemodynamic monitoring can detect changes in intracardiac filling pressure weeks prior to HF-related hospitalizations which makes timely pharmacological interventions possible. To ensure successful implementation, structural integration, optimal patient selection, and efficient data management are essential. This review aims to provide an overview of the rationale, the available devices, current evidence, and the implementation of remote hemodynamic monitoring.
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Affiliation(s)
- P R D Clephas
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - R A de Boer
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
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13
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Lundgren SW, Garvin RP, Abraham WT. Hemodynamic Monitoring Devices in the Management of Outpatient Heart Failure. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101186. [PMID: 39131070 PMCID: PMC11307516 DOI: 10.1016/j.jscai.2023.101186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 08/13/2024]
Abstract
The prevalence of heart failure continues to increase throughout the world. This rise in diagnoses corresponds with high rates of hospitalization, patient and caregiver fatigue, and ever-increasing economic costs. While numerous investigations have been undertaken in the past looking into remote monitoring or telemedicine strategies, they were unable to show an improvement in clinical outcomes with use. Invasive hemodynamic monitoring in the ambulatory setting has been an area of focus for the last several decades as a possible proactive strategy aiding in the evaluation and management of the heart failure population. Several large, randomized trials have not only shown the safety of a pulmonary artery pressure sensor in the heart failure population but have also confirmed the efficacy of pulmonary artery pressure-guided heart failure management in reducing rates of heart failure hospitalizations. Additional novel implantable devices are in various stages of development and clinical investigation and aim to further help aid in the management of this complex patient population. Future strategies are emerging and include the increased development of wearable devices as well as novel technologies to assess hemodynamics and volume status.
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Affiliation(s)
- Scott W. Lundgren
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert P. Garvin
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
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14
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Clephas PRD, Radhoe SP, Boersma E, Gregson J, Jhund PS, Abraham WT, McMurray JJV, de Boer RA, Brugts JJ. Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure: a meta-analysis of three randomized controlled trials. Eur Heart J 2023; 44:3658-3668. [PMID: 37210750 PMCID: PMC10542655 DOI: 10.1093/eurheartj/ehad346] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question. METHODS AND RESULTS A systematic literature search was performed for randomized clinical trials with PA pressure monitoring devices in patients with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Three eligible randomized clinical trials were identified that included 1898 outpatients in New York Heart Association functional classes II-IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. The mean follow-up was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58-0.86) (P = .0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61-0.91; P = .0037) and for all-cause mortality 0.92 (0.73-1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect. CONCLUSION The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations.
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Affiliation(s)
- Pascal R D Clephas
- Department of Cardiology, Erasmus MC University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Sumant P Radhoe
- Department of Cardiology, Erasmus MC University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus MC University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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15
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Kobe EA, McVeigh T, Hameed I, Fudim M. Heart Failure Remote Monitoring: A Review and Implementation How-To. J Clin Med 2023; 12:6200. [PMID: 37834845 PMCID: PMC10573601 DOI: 10.3390/jcm12196200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Heart failure (HF) is a significant clinical and financial burden worldwide. Remote monitoring (RM) devices capable of identifying early physiologic changes in decompensation have the potential to reduce the HF burden. However, few trials have discussed at length the practical aspects of implementing RM in real-world clinical practice. The present paper reviews current RM devices and clinical trials, focusing on patient populations, outcomes, data collection, storage, and management, and describes the implementation of an RM device in clinical practice, providing a pragmatic and adaptable framework.
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Affiliation(s)
- Elizabeth A. Kobe
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Todd McVeigh
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ishaque Hameed
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
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16
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Scholte NTB, Gürgöze MT, Aydin D, Theuns DAMJ, Manintveld OC, Ronner E, Boersma E, de Boer RA, van der Boon RMA, Brugts JJ. Telemonitoring for heart failure: a meta-analysis. Eur Heart J 2023; 44:2911-2926. [PMID: 37216272 PMCID: PMC10424885 DOI: 10.1093/eurheartj/ehad280] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided. METHODS AND RESULTS A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996-July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77-0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74-0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76-0.96, I2: 70%). CONCLUSION These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS.
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Affiliation(s)
- Niels T B Scholte
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Muhammed T Gürgöze
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dilan Aydin
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Eelko Ronner
- Department of Cardiology, Reinier de Graaf Hospital, Reinier de Graafweg 5, Delft, South Holland 2625 AD, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
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17
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Schneider D, Köhler K, Köhler F. [Telemedicine in cardiology - what is new?]. Dtsch Med Wochenschr 2023; 148:767-773. [PMID: 37257479 DOI: 10.1055/a-1928-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is robust evidence for the clinical efficacy of telemedicine in heart failure (HF) patients to reduce mortality and morbidity. For the first time, the Federal Joint Committee (G-BA) has approved telemedicine for HF patients as a digital method of care for a well-defined heart failure population. Patients with HF and a reduced left ventricular ejection fraction (LVEF ) < 40 % are now eligible for telemonitoring in a real-world settings of out-patient care in Germany. The implementation of telemedicine in the German health care system is a complex process including the introduction of telemedical technologies, educational programs for the patients as well as the implementation of standard operating procedures (SOPs) for the staff of telemedical centers. The ongoing research in telemedicine in HF patients is focusing on three issues: a) research to extend the suitable HF-population for telemonitoring; b) research on new telemedical sensor technologies, e.g. a new pulmonary pressure measurement system (Cordella) and a system for wireless measurement of left atrial pressure (V-LAP); c) the introduction of methods of artifical intelligence (AI), e.g. the AI-based speech analysis using a smart phone to characterize the pulmonary fluid status.
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Affiliation(s)
- David Schneider
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Deutschland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Kerstin Köhler
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Berlin, Deutschland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Friedrich Köhler
- Deutsches Herzzentrum der Charité, Arbeitsbereich Kardiovaskuläre Telemedizin, Berlin, Deutschland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
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18
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Taylor JK, Ahmed FZ. Clinical Pathways Guided by Remotely Monitoring Cardiac Device Data: The Future of Device Heart Failure Management? Arrhythm Electrophysiol Rev 2023; 12:e15. [PMID: 37427299 PMCID: PMC10326671 DOI: 10.15420/aer.2022.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/03/2022] [Indexed: 07/11/2023] Open
Abstract
Research examining the utility of cardiac device data to manage patients with heart failure (HF) is rapidly evolving. COVID-19 has reignited interest in remote monitoring, with manufacturers each developing and testing new ways to detect acute HF episodes, risk stratify patients and support self-care. As standalone diagnostic tools, individual physiological metrics and algorithm-based systems have demonstrated utility in predicting future events, but the integration of remote monitoring data with existing clinical care pathways for device HF patients is not well described. This narrative review provides an overview of device-based HF diagnostics available to care providers in the UK, and describes the current state of play with regard to how these systems fit in with current HF management.
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Affiliation(s)
- Joanne K Taylor
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Fozia Zahir Ahmed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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19
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Latib A, Hashim Mustehsan M, Abraham WT, Jorde UP, Bartunek J. Transcatheter interventions for heart failure. EUROINTERVENTION 2023; 18:1135-1149. [PMID: 36861266 PMCID: PMC9936253 DOI: 10.4244/eij-d-22-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/21/2022] [Indexed: 02/19/2023]
Abstract
Despite significant advances in the medical management of patients living with heart failure, there continues to be significant morbidity and mortality associated with the condition. There is a growing need for research and development of additional modalities to fill the management and treatment gaps, reduce hospitalisations and improve the quality of life for patients living with heart failure. In the last decade, there has been a rapid rise in the use of non-valvular catheter-based therapies for the management of chronic heart failure to complement existing guideline-directed management. They target well-defined mechanistic and pathophysiological processes critical to the progression of heart failure including left ventricular remodelling, neurohumoral activation, and congestion. In this review, we will explore the physiology, rationale, and current stages of the clinical development of the existing procedures.
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Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, The Bronx, NY, USA
| | | | - William T Abraham
- Division of Cardiology, The Ohio State University, Columbus, OH, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, The Bronx, NY, USA
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20
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Guichard JL, Cowger JA, Chaparro SV, Kiernan MS, Mullens W, Mahr C, Mullin C, Forouzan O, Hiivala NJ, Sauerland A, Leadley K, Klein L. Rationale and Design of the Proactive-HF Trial for Managing Patients With NYHA Class III Heart Failure by Using the Combined Cordella Pulmonary Artery Sensor and the Cordella Heart Failure System. J Card Fail 2023; 29:171-180. [PMID: 36191758 DOI: 10.1016/j.cardfail.2022.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Optimizing guideline-directed medical therapy (GDMT) and monitoring congestion in patients with heart failure (HF) are key to disease management and preventing hospitalizations. A pulmonary artery pressure (PAP)-guided HF management system providing access to body weight, blood pressure, heart rate, blood oxygen saturation, PAP, and symptoms, may provide new insights into the effects of patient engagement and comprehensive care for remote GDMT titration and congestion management. METHODS The PROACTIVE-HF study was originally approved in 2018 as a prospective, randomized, controlled, single-blind, multicenter trial to evaluate the safety and effectiveness of the Cordella PAP Sensor in patients with HF and with New York Heart Association (NYHA) functional class III symptoms. Since then, robust clinical evidence supporting PAP-guided HF management has emerged, making clinical equipoise and enrolling patients into a standard-of-care control arm challenging. Therefore, PROACTIVE-HF was changed to a single-arm trial in 2021 with prespecified safety and effectiveness endpoints to provide evidence for a similar risk/benefit profile as the CardioMEMS HF System. CONCLUSION The single-arm PROACTIVE-HF trial is expected to further demonstrate the benefits of PAP-guided HF management of patients with NYHA class III HF. The addition of vital signs, patient engagement and self-reported symptoms may provide new insights into remote GDMT titration and congestion management.
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Affiliation(s)
- Jason L Guichard
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, Greenville, South Carolina, United States
| | - Jennifer A Cowger
- Department of Medicine, Division of Cardiology, Henry Ford Health, Detroit, Michigan, United States
| | - Sandra V Chaparro
- Miami Cardiac and Vascular Institute, Division of Cardiology, Baptist South Florida, Miami, Florida, United States
| | - Michael S Kiernan
- Department of Medicine, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, United States
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Chris Mullin
- NAMSA, Product Development Strategy, Saint Paul, Minnesota, United States
| | - Omid Forouzan
- Clinical Development, Endotronix, Lisle, Chicago, Illinois, United States
| | - Nicholas J Hiivala
- Clinical Development, Endotronix, Lisle, Chicago, Illinois, United States
| | - Andrea Sauerland
- Clinical Development, Endotronix, Lisle, Chicago, Illinois, United States
| | | | - Liviu Klein
- Advanced Heart Failure Comprehensive Care Center and Division of Cardiology, University of California San Francisco, San Francisco, California, United States.
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Clephas PRD, Aydin D, Radhoe SP, Brugts JJ. Recent Advances in Remote Pulmonary Artery Pressure Monitoring for Patients with Chronic Heart Failure: Current Evidence and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031364. [PMID: 36772403 PMCID: PMC9921931 DOI: 10.3390/s23031364] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 05/27/2023]
Abstract
Chronic heart failure (HF) is associated with high hospital admission rates and has an enormous burden on hospital resources worldwide. Ideally, detection of worsening HF in an early phase would allow physicians to intervene timely and proactively in order to prevent HF-related hospitalizations, a concept better known as remote hemodynamic monitoring. After years of research, remote monitoring of pulmonary artery pressures (PAP) has emerged as the most successful technique for ambulatory hemodynamic monitoring in HF patients to date. Currently, the CardioMEMS and Cordella HF systems have been tested for pulmonary artery pressure monitoring and the body of evidence has been growing rapidly over the past years. However, several ongoing studies are aiming to fill the gap in evidence that is still very clinically relevant, especially for the European setting. In this comprehensive review, we provide an overview of all available evidence for PAP monitoring as well as a detailed discussion of currently ongoing studies and future perspectives for this promising technique that is likely to impact HF care worldwide.
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Perl L, Feickert S, D'Amario D. Editorial: Advances and challenges in remote monitoring of patients with heart failure. Front Cardiovasc Med 2022; 9:1021296. [PMID: 36172588 PMCID: PMC9511161 DOI: 10.3389/fcvm.2022.1021296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Leor Perl
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Leor Perl ;
| | - Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum Am Urban, Berlin and Rostock University Medical Center, Rostock, Germany
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Domenico D'Amario
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