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Maraey A, Chacko P, Moukarbel GV. Thoracic impedance monitoring in heart failure: from theory to practice. Expert Rev Med Devices 2024:1-4. [PMID: 38655906 DOI: 10.1080/17434440.2024.2347412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
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2
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Filippini FB, Ribeiro HB, Bocchi E, Bacal F, Marcondes-Braga FG, Avila MS, Sturmer JD, Marchi MFDS, Kanhouche G, Freire AF, Cassar R, Abizaid AA, de Brito FS. Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. Arq Bras Cardiol 2023; 120:e20220496. [PMID: 38126512 PMCID: PMC10773459 DOI: 10.36660/abc.20220496] [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: 07/11/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
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Affiliation(s)
- Filippe Barcellos Filippini
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Henrique Barbosa Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Edimar Bocchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fernando Bacal
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Monica S. Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Janine Daiana Sturmer
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Mauricio Felippi de Sá Marchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Antônio Fernando Freire
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Renata Cassar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Alexandre A. Abizaid
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
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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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4
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Ha GB, Steinberg BA, Freedman R, Bayés-Genís A, Sanchez B. Safety evaluation of smart scales, smart watches, and smart rings with bioimpedance technology shows evidence of potential interference in cardiac implantable electronic devices. Heart Rhythm 2023; 20:561-571. [PMID: 36997272 DOI: 10.1016/j.hrthm.2022.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Smart scales, smart watches, and smart rings with bioimpedance technology may create interference in patients with cardiac implantable electronic devices (CIEDs). OBJECTIVES The purpose of this study was to determine interference at CIEDs with simulations and benchtop testing, and to compare the results with maximum values defined in the ISO 14117 electromagnetic interference standard for these devices. METHODS The interference at pacing electrodes was determined by simulations on a male and a female computable model. A benchtop evaluation of representative CIEDs from 3 different manufacturers as specified in the ISO 14117 standard also was performed. RESULTS Simulations showed evidence of interference with voltage values exceeding threshold values defined in the ISO 14117 standard. The level of interference varied with the frequency and amplitude of the bioimpedance signal, and between male and female models. The level of interference generated with smart scale and smart rings simulations was lower than with smart watches. Across device manufacturers, generators demonstrated susceptibility to oversensing and pacing inhibition at different signal amplitudes and frequencies. CONCLUSIONS This study evaluated the safety of smart scales, smart watches, and smart rings with bioimpedance technology via simulation and testing. Our results indicate that these consumer electronic devices could interfere in patients with CIEDs. The present findings do not recommend the use of these devices in this population due to potential interference.
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Affiliation(s)
- Gia-Bao Ha
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah
| | - Benjamin A Steinberg
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Roger Freedman
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Antoni Bayés-Genís
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Benjamin Sanchez
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah.
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Assa S, Vernooy K, van Stipdonk AMW. Cardiovascular Implantable Electronic Devices Enabled Remote Heart Failure Monitoring; What We Have Learned and Where to Go Next. J Cardiovasc Dev Dis 2023; 10:jcdd10040152. [PMID: 37103031 PMCID: PMC10142884 DOI: 10.3390/jcdd10040152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Despite recent developments, heart failure (HF) remains to be a great burden to the individual patient, entailing major morbidity and mortality. Moreover, HF is a great burden to overall healthcare, mainly because of frequent hospitalizations. Timely diagnosis of HF deterioration and implementation of appropriate therapy may prevent hospitalization and eventually improve a patient’s prognosis; however, depending on the patient’s presentation, the signs and symptoms of HF often offer too little therapeutic window to prevent hospitalizations. Cardiovascular implantable electronic devices (CIEDs) can provide real-time physiologic parameters and remote monitoring of these parameters can potentially help to identify patients at high risk. However, routine implementation of remote monitoring of CIEDs has still not been widely used in daily patient care. This review gives a detailed description of available metrics for remote HF monitoring, the studies that provide evidence of their efficacy, ways to implement them in clinical HF practice, as well as lessons learned on where to go on from where we currently are.
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Affiliation(s)
- Solmaz Assa
- Department of Cardiology, Treant Zorggroep, 7824 AA Emmen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Antonius M. W. van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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Krzesiński P. Digital Health Technologies for Post-Discharge Care after Heart Failure Hospitalisation to Relieve Symptoms and Improve Clinical Outcomes. J Clin Med 2023; 12:2373. [PMID: 36983375 PMCID: PMC10058646 DOI: 10.3390/jcm12062373] [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: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
The prevention of recurrent heart failure (HF) hospitalisations is of particular importance, as each such successive event may increase the risk of death. Effective care planning during the vulnerable phase after discharge is crucial for symptom control and improving patient prognosis. Many clinical trials have focused on telemedicine interventions in HF, with varying effects on the primary endpoints. However, the evidence of the effectiveness of telemedicine solutions in cardiology is growing. The scope of this review is to present complementary telemedicine modalities that can support outpatient care of patients recently hospitalised due to worsening HF. Remote disease management models, such as video (tele) consultations, structured telephone support, and remote monitoring of vital signs, were presented as core components of telecare. Invasive and non-invasive monitoring of volume status was described as an important step forward to prevent congestion-the main cause of clinical decompensation. The idea of virtual wards, combining these facilities with in-person visits, strengthens the opportunity for education and enhancement to promote more intensive self-care. Electronic platforms provide coordination of tasks within multidisciplinary teams and structured data that can be effectively used to develop predictive algorithms based on advanced digital science, such as artificial intelligence. The rapid progress in informatics, telematics, and device technologies provides a wide range of possibilities for further development in this area. However, there are still existing gaps regarding the use of telemedicine solutions in HF patients, and future randomised telemedicine trials and real-life registries are still definitely needed.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine-National Research Institute, Szaserow Street 128, 04-141 Warsaw, Poland
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7
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Mastoris I, DeFilippis EM, Martyn T, Morris AA, Van Spall HG, Sauer AJ, J Sauer A. Remote Patient Monitoring for Patients with Heart Failure: Sex- and Race-based Disparities and Opportunities. Card Fail Rev 2023; 9:e02. [PMID: 36891178 PMCID: PMC9987513 DOI: 10.15420/cfr.2022.22] [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: 05/22/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
Remote patient monitoring (RPM), within the larger context of telehealth expansion, has been established as an effective and safe means of care for patients with heart failure (HF) during the recent pandemic. Of the demographic groups, female patients and black patients are underenrolled relative to disease distribution in clinical trials and are under-referred for RPM, including remote haemodynamic monitoring, cardiac implantable electronic devices (CIEDs), wearables and telehealth interventions. The sex- and race-based disparities are multifactorial: stringent clinical trial inclusion criteria, distrust of the medical establishment, poor access to healthcare, socioeconomic inequities, and lack of diversity in clinical trial leadership. Notwithstanding addressing the above factors, RPM has the unique potential to reduce disparities through a combination of implicit bias mitigation and earlier detection and intervention for HF disease progression in disadvantaged groups. This review describes the uptake of remote haemodynamic monitoring, CIEDs and telehealth in female patients and black patients with HF, and discusses aetiologies that may contribute to inequities and strategies to promote health equity.
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Affiliation(s)
- Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital Boston, Massachusetts, US
| | | | - Trejeeve Martyn
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Ohio, US
| | - Alanna A Morris
- Department of Medicine, Emory University School of Medicine Georgia, US
| | - Harriette Gc Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University Hamilton, Canada.,Population Health Research Institute and Research Institute of St Joseph's Hamilton, Canada
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City, Missouri, US
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Sandys V, Sexton D, O'Seaghdha C. Artificial intelligence and digital health for volume maintenance in hemodialysis patients. Hemodial Int 2022; 26:480-495. [PMID: 35739632 PMCID: PMC9796027 DOI: 10.1111/hdi.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Chronic fluid overload is associated with morbidity and mortality in hemodialysis patients. Optimizing the diagnosis and treatment of fluid overload remains a priority for the nephrology community. Although current methods of assessing fluid status, such as bioimpedance and lung ultrasound, have prognostic and diagnostic value, no single system or technique can be used to maintain euvolemia. The difficulty in maintaining and assessing fluid status led to a publication by the Kidney Health Initiative in 2019 aimed at fostering innovation in fluid management therapies. This review article focuses on the current limitations in our assessment of extracellular volume, and the novel technology and methods that can create a new paradigm for fluid management. The cardiology community has published research on multiparametric wearable devices that can create individualized predictions for heart failure events. In the future, similar wearable technology may be capable of tracking fluid changes during the interdialytic period and enabling behavioral change. Machine learning methods have shown promise in the prediction of volume-related adverse events. Similar methods can be leveraged to create accurate, automated predictions of dry weight that can potentially be used to guide ultrafiltration targets and interdialytic weight gain goals.
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Affiliation(s)
- Vicki Sandys
- Royal College of Surgeons in IrelandDublinIreland
| | - Donal Sexton
- St James's HospitalDublin 8Ireland,Trinity Health Kidney CentreSchool of Medicine, Trinity College DublinDublinIreland,ADAPT: Research Centre for AI‐Driven Digital Content TechnologyIreland
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Tratamiento a distancia de la insuficiencia cardiaca mediante el algoritmo HeartLogic. Registro RE-HEART. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Hernandez AF, Albert NM, Allen LA, Ahmed R, Averina V, Boehmer JP, Cowie MR, Chien CV, Galvao M, Klein L, Kwan B, Lam CSP, Ruble SB, Stolen CM, Stein K. Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure. J Card Fail 2022; 28:1245-1254. [PMID: 35460884 DOI: 10.1016/j.cardfail.2022.03.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction (HFrEF) suffer from a relapsing and remitting disease, where early treatment changes may improve outcomes. We assessed the clinical integration and safety of the HeartLogic multi-sensor index and alerts in heart failure care. METHODS The Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) study enrolled 200 patients with HFrEF (< 35%), NYHA class II-III symptoms, implanted with a CRT-D or ICD, who had either a hospitalization for HF within 12 months or unscheduled visit for HF exacerbation within 90 days or an elevated natriuretic peptide concentration (BNP≥150 pg/mL or NT-proBNP≥600 pg/mL). This phase included development of an alert management guide and evaluated changes in medical treatment, natriuretic peptide levels, and safety. RESULTS Mean age of participants was 67 years, 68% were men, 81% were white, and 61% had a HF hospitalization in prior 12 months. During follow-up there were 585 alert cases with an average of 1.76 alert cases/pt-yr. HF medications were augmented during 74% of the alert cases. HF treatment augmentation within 2 weeks from an initial alert was associated with more rapid recovery of the HeartLogic Index. Five SAEs (0.015 per pt-year) occurred in relation to alert-prompted medication change. NTproBNP levels decreased from median of 1316 pg/mL at baseline to 743 pg/mL at 12 months (p<0.001). CONCLUSIONS HeartLogic alert management was safely implemented in HF care and may optimize HF management. This phase supports further evaluation in larger studies. TRIAL REGISTRATION ClinicalTrials.gov (NCT03237858).
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Affiliation(s)
- Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Nancy M Albert
- Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - John P Boehmer
- Division of Cardiology, Department of Medicine Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin R Cowie
- Royal Brompton Hospital & Faculty of Lifesciences & Medicine, King's College London, London, United Kingdom
| | - Christopher V Chien
- Division of Cardiology, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Marie Galvao
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, UC San Francisco, San Francisco, CA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore & Duke National University of Singapore, Singapore
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11
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Remote heart failure management using the HeartLogic algorithm. RE-HEART Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 75:709-716. [PMID: 34896031 DOI: 10.1016/j.rec.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). CONCLUSIONS The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
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12
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Evaluation of Medicare Claims for the Development of Heart Failure Diagnostics. J Card Fail 2021; 28:756-764. [PMID: 34775112 DOI: 10.1016/j.cardfail.2021.11.008] [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: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although claims data provide a large and efficient source of clinical events, validation is needed prior to use in heart failure (HF) diagnostic development. METHODS AND RESULTS Data from the Multisensor Chronic Evaluations in Ambulatory Heart Failure Patients (MultiSENSE) study, used to create the HeartLogic HF diagnostic, were linked with fee-for-service (FFS) Medicare claims. Events were matched by patient ID and date, and agreement was calculated between claims primary HF diagnosis codes and study event adjudication. HF events (HFEs) were defined as inpatient visits, or outpatient visits with intravenous decongestive therapy. Diagnostic performance was measured as HFE-detection sensitivity and false-positive rate (FPR). Linkage of 791 MultiSENSE subjects returned 320 FFS patients with an average follow-up duration of 0.94 years. Although study and claims deaths matched exactly (n = 14), matching was imperfect between study hospitalizations and acute inpatient claims events. Of 239 total events, 165 study hospitalizations (69%) matched inpatient claims events, 28 hospitalizations matched outpatient claims events (12%), 14 hospitalizations were study-unique (6%), and 32 inpatient events were claims-unique (13%). Inpatient HF classification had substantial agreement with study adjudication (κ = 0.823). Diagnostic performance was not different between claims and study events (sensitivity = 75.6% vs 77.6% and FPR = 1.539 vs 1.528 alerts/patient-year). HeartLogic-detected events contributed to > 90% of the HFE costs used for evaluation. CONCLUSIONS Acceptable event matching, good agreement of claims diagnostic codes with adjudication, and equivalent diagnostic performance support the validity of using claims for HF diagnostic development.
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Mastoris I, Spall HGCV, Sheldon SH, Pimentel RC, Steinkamp L, Shah Z, Al-Khatib SM, Singh JP, Sauer AJ. Emerging Implantable Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care. J Card Fail 2021; 28:991-1015. [PMID: 34774748 DOI: 10.1016/j.cardfail.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/01/2023]
Abstract
Cardiac implantable electronic devices (CIEDs), including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT), are part of guideline- indicated treatment for a subset of patients with heart failure with reduced ejection fraction (HFrEF). Current technological advancements in CIEDs have allowed the detection of specific patient physiologic parameters used for forecasting clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation (CCM) and baroreflex activation therapy (BAT), may provide symptomatic or physiologic benefit in patients without an indication for CRT. Our goal in this state-of-the-art review is to describe the commercially available new technologies, purported mechanisms of action, evidence surrounding their clinical role, limitations, and future directions. Finally, we underline the need for standardized workflow and close interdisciplinary management of this population to ensure the delivery of high-quality care.
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Affiliation(s)
- Ioannis Mastoris
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Rhea C Pimentel
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Leslie Steinkamp
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas.
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Theuns DAMJ, Radhoe SP, Brugts JJ. Remote Monitoring of Heart Failure in Patients with Implantable Cardioverter-Defibrillators: Current Status and Future Needs. SENSORS 2021; 21:s21113763. [PMID: 34071624 PMCID: PMC8198327 DOI: 10.3390/s21113763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.
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15
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Mason PK, Desai A, Ajijola OA, Amin AK, Barbhaiya C, Basil A, DeBiasi R, Dukes J, Fradley M, Ismail H, Jackson L, Mendelson T, Montgomery J, Orencole MP, Syed FF, Wan E, Zilinski J, Singh JP. Integrated electrophysiology care for patients with heart failure: An envisioned future. Heart Rhythm 2021; 18:e51-e63. [PMID: 33065255 DOI: 10.1016/j.hrthm.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Akshay Desai
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Anish K Amin
- Riverside Methodist Hospital, Upper Arlington, Ohio
| | | | - Anuj Basil
- Temple University, Philadelphia, Pennsylvania
| | - Ralph DeBiasi
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | - Larry Jackson
- Duke University Medical Center, Durham, North Carolina
| | - Todd Mendelson
- Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Jay Montgomery
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Faisal F Syed
- University of North Carolina, Chapel Hill, North Carolina
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16
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Mohebali D, Kittleson MM. Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic. Heart 2021; 107:366-372. [PMID: 33431425 DOI: 10.1136/heartjnl-2020-318062] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.
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Affiliation(s)
- Donya Mohebali
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Heart Institute, Los Angeles, California, USA
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17
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18
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Abstract
Heart failure is a chronic disease with a multitude of different clinical manifestations. Empowering people living with heart failure requires education, support structure, understanding the needs of patients, and reimaging the care delivery systems currently offered to patients. In this article, the authors discuss practical approaches to activate and empower people with heart failure and enable patient-provider dialogue and shared decision making.
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Affiliation(s)
- Peter Wohlfahrt
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA; Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Irene Z Pan
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA; College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
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19
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Stehlik J, Schmalfuss C, Bozkurt B, Nativi-Nicolau J, Wohlfahrt P, Wegerich S, Rose K, Ray R, Schofield R, Deswal A, Sekaric J, Anand S, Richards D, Hanson H, Pipke M, Pham M. Continuous Wearable Monitoring Analytics Predict Heart Failure Hospitalization. Circ Heart Fail 2020; 13:e006513. [DOI: 10.1161/circheartfailure.119.006513] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Implantable cardiac sensors have shown promise in reducing rehospitalization for heart failure (HF), but the efficacy of noninvasive approaches has not been determined. The objective of this study was to determine the accuracy of noninvasive remote monitoring in predicting HF rehospitalization.
Methods:
The LINK-HF study (Multisensor Non-invasive Remote Monitoring for Prediction of Heart Failure Exacerbation) examined the performance of a personalized analytical platform using continuous data streams to predict rehospitalization after HF admission. Study subjects were monitored for up to 3 months using a disposable multisensor patch placed on the chest that recorded physiological data. Data were uploaded continuously via smartphone to a cloud analytics platform. Machine learning was used to design a prognostic algorithm to detect HF exacerbation. Clinical events were formally adjudicated.
Results:
One hundred subjects aged 68.4±10.2 years (98% male) were enrolled. After discharge, the analytical platform derived a personalized baseline model of expected physiological values. Differences between baseline model estimated vital signs and actual monitored values were used to trigger a clinical alert. There were 35 unplanned nontrauma hospitalization events, including 24 worsening HF events. The platform was able to detect precursors of hospitalization for HF exacerbation with 76% to 88% sensitivity and 85% specificity. Median time between initial alert and readmission was 6.5 (4.2–13.7) days.
Conclusions:
Multivariate physiological telemetry from a wearable sensor can provide accurate early detection of impending rehospitalization with a predictive accuracy comparable to implanted devices. The clinical efficacy and generalizability of this low-cost noninvasive approach to rehospitalization mitigation should be further tested.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique Identifier: NCT03037710.
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Affiliation(s)
- Josef Stehlik
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | | | - Biykem Bozkurt
- Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (B.B., A.D.)
| | - Jose Nativi-Nicolau
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | - Peter Wohlfahrt
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | | | - Kevin Rose
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Ranjan Ray
- VA Palo Alto Health Care System, Palo Alto, CA (R.R., M.P.)
| | | | - Anita Deswal
- Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (B.B., A.D.)
| | | | - Sebastian Anand
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Dylan Richards
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Heather Hanson
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
| | - Matthew Pipke
- VA Palo Alto Health Care System, Palo Alto, CA (R.R., M.P.)
| | - Michael Pham
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
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20
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Segmental Bioelectrical Impedance Spectroscopy to Monitor Fluid Status in Heart Failure. Sci Rep 2020; 10:3577. [PMID: 32109235 PMCID: PMC7046702 DOI: 10.1038/s41598-020-60358-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/05/2020] [Indexed: 01/10/2023] Open
Abstract
Bioelectrical impedance spectroscopy (BIS) measures body composition, including fluid status. Acute decompensated heart failure (ADHF) is associated with fluid overload in different body compartments. This investigation aimed to evaluate the feasibility of measuring and monitoring fluid accumulation in patients with ADHF using BIS. The extracellular impedance as a surrogate marker for fluid accumulation was measured in 67 participants (25 healthy reference volunteers and 42 patients admitted with ADHF) using BIS in the “transthoracic”, “foot-to-foot”, “whole-body” and “hand-to-hand” segments. At baseline, BIS showed significantly lower extracellular resistance values for the “whole-body” (P < 0.001), “foot-to-foot” (P = 0.03), “hand-to-hand” (P < 0.001) and “transthoracic” (P = 0.014) segments in patients with ADHF than the reference cohort, revealing a specific pattern for peripheral, central and general fluid accumulation. The “foot-to-foot” (AUC = 0.8, P < 0.001) and “hand-to-hand” (AUC = 0.74, P = 0.04) segments indicated compartments of fluid accumulation with good prediction. During cardiac recompensation, BIS values changed significantly and were in line with routine parameters for monitoring ADHF. Mean bodyweight change per day correlated moderately to good with BIS values in the “whole-body” (r = −0.4), “foot-to-foot” (r = −0.8) and “transthoracic” (r = −0.4) segments. Based on our analysis, we conclude that measuring and monitoring fluid accumulation in ADHF using segmental BIS is feasible and correlates with clinical parameters during recompensation.
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21
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Selzman KA, Patel H, Cavanaugh K. Electrophysiology devices and the regulatory approval process within the U.S. FDA and abroad. J Interv Card Electrophysiol 2019; 56:173-182. [PMID: 31418099 DOI: 10.1007/s10840-019-00607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
Almost all electrophysiology (EP) devices need to obtain premarket approval before they can be commercially sold and available for use in the community. The US Food and Drug Administration (FDA) has different paths to market approval depending on the intended use and the associated risks of the device. The European Union and Japan have device approval processes that have many similarities as well as differences to the US regulatory system. This paper describes some of the history and background of the US device approval process with an emphasis on EP devices. It provides an overview of the different regulatory pathways in the USA that are currently being utilized and contrasts them to the procedures often used in the European Union and in Japan. It also touches on the impact of the twenty-first Century Cures Act and how the balance between premarket and postmarket regulatory oversight is continually being examined and refined.
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Affiliation(s)
- Kimberly A Selzman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.
| | - Hetal Patel
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Kenneth Cavanaugh
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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22
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Maier SKG, Paule S, Jung W, Koller M, Ventura R, Quesada A, Bordachar P, García-Fernández FJ, Schumacher B, Lobitz N, Takizawa K, Ando K, Adachi K, Shoda M. Evaluation of thoracic impedance trends for implant-based remote monitoring in heart failure patients - Results from the (J-)HomeCARE-II Study. J Electrocardiol 2019; 53:100-108. [PMID: 30739055 DOI: 10.1016/j.jelectrocard.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 12/23/2022]
Abstract
AIMS Remote monitoring by implantable devices substantially improves management of heart failure (HF) patients by providing diagnostic day-to-day data. The use of thoracic impedance (TI) as a surrogate measure of fluid accumulation is still strongly debated. The multicenter HomeCARE-II study evaluated clinically apparent HF events in the context of remote device diagnostics, focusing on the controversial role of TI. METHODS AND RESULTS We followed 497 patients (66.6 ± 10.1 years, 77% male, QRS 139.8 ± 36.0 ms, ejection fraction 26.8 ± 7.0%) implanted with a CRT-D (67%) or an ICD (33%) for 21.4 ± 8.1 months. An independent event committee confirmed 171 HF events of which 82 were used to develop a TI-based algorithm for the prediction of imminent cardiac decompensation. Highly inter-individual variations in patterns of TI trends were observed. The algorithm resulted in a sensitivity of 41.5% (50.0%) with 0.95 (1.34) false alerts per patient year, and a positive predictive value of 7.9% overall and 27.9% in the HF event group of patients. Averaged ratio statistics showed a significant pre-hospital decrease and a highly significant in-hospital increase in TI after intensified diuresis. Recurrent decompensations turned out to be preceded by a significantly stronger decrease of TI compared to first events with a higher chance for detection (63.6% sensitivity, p < 0.05). CONCLUSIONS Overall performance in predicting imminent decompensation by monitoring TI alone is limited due to its high inter-patient variability. TI stand-alone applications should be redirected towards a target population with more advanced symptoms where post-hospital observation aimed to maintain the patient's discharge status might be the most valuable approach. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00711360 (HomeCARE-II) and NCT01221649 (J-HomeCARE-II).
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Affiliation(s)
- Sebastian K G Maier
- Medizinische Klinik II, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany; Comprehensive Heart Failure Center, Würzburg, Germany.
| | | | - Werner Jung
- Klinik für Innere Medizin III, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Marcus Koller
- Medizinische Klinik II, Kardiologie/Elektrophysiologie, Klinikum Kaufbeuren, Kaufbeuren, Germany
| | - Rodolfo Ventura
- Elektrophysiologie Bremen, Zentrum Bremen/Lilienthal, Bremen, Germany
| | - Aurelio Quesada
- Cardiology Department, Hospital General Universitario, Valencia, Spain
| | | | | | - Burghard Schumacher
- Klinik für Innere Medizin 2, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | | | - Kaname Takizawa
- Division of Cardiology, Cardiovascular Center, Sendai Kousei Hospital, Sendai, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazumasa Adachi
- Department of Cardiology, Akashi Medical Center, Hyogo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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23
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Palfy JA, Benezet-Mazuecos J, Martinez Milla J, Iglesias JA, de la Vieja JJ, Sanchez-Borque P, Miracle A, Rubio JM. CorVue algorithm efficacy to predict heart failure in real life: Unnecessary and potentially misleading information? Pacing Clin Electrophysiol 2018; 41:948-952. [PMID: 29856082 DOI: 10.1111/pace.13399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/28/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart failure (HF) hospitalizations have a negative impact on quality of life and imply important costs. Intrathoracic impedance (ITI) variations detected by cardiac devices have been hypothesized to predict HF hospitalizations. Although Optivol™ algorithm (Medtronic, Minneapolis, MN, USA) has been widely studied, CorVue™ algorithm's (St. Jude Medical, St. Paul, MN, USA) long-term efficacy has not been systematically evaluated in a "real-life" cohort. METHODS CorVue™ was activated in implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) patients to store information about ITI measures. Clinical events (new episodes of HF requiring treatment and hospitalizations) and CorVue™ data were recorded every 3 months. Appropriate CorVue™ detection for HF was considered if it occurred in the 4 prior weeks to the clinical event. RESULTS Fifty-three ICD/CRT-D (26 ICD and 27 CRT-D) patients (67 ± 1 years old, 79% male) were included. Device position was subcutaneous in 28 patients. At inclusion, mean left ventricular ejection fraction was 25 ± 7% and 27 patients (51%) were in New York Heart Association class I, 18 (34%) in class II, and eight (15%) in class III. After a mean follow-up of 17 ± 9 months, 105 ITI drops alarms were detected in 32 patients (60%). Only six alarms were appropriate (true positive) and required hospitalization. Eighteen patients (34%) presented 25 clinical episodes (12 hospitalizations and 13 emergency room/ambulatory treatment modifications). Nineteen of these clinical episodes (76%) remained undetected by the CorVue™ (false negative). Sensitivity of CorVue™ resulted in 24%, specificity was 70%, positive predictive value of 6%, and negative predictive value of 93%. CONCLUSIONS CorVue™ showed a low sensitivity to predict HF events. Therefore, routinely activation of this algorithm could generate misleading information.
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Affiliation(s)
- Julia Anna Palfy
- General Cardiology, Cardiology Department of Hospital, Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Juan Benezet-Mazuecos
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Juan Martinez Milla
- General Cardiology, Cardiology Department of Hospital, Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Jose Antonio Iglesias
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Juan Jose de la Vieja
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Pepa Sanchez-Borque
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Angel Miracle
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
| | - Jose Manuel Rubio
- Electrophysiology Unit, Cardiology Department of Hospital Universitario Fundación Jiménez Diaz-Quironsalud, Madrid, Spain
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24
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Pevnick JM, Birkeland K, Zimmer R, Elad Y, Kedan I. Wearable technology for cardiology: An update and framework for the future. Trends Cardiovasc Med 2018; 28:144-150. [PMID: 28818431 PMCID: PMC5762264 DOI: 10.1016/j.tcm.2017.08.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/03/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
Abstract
The field of cardiology has long used wearable medical devices to monitor heart rate and rhythm. The past decade has seen the emergence of many new wearable devices, including several that have been widely adopted by both physicians and consumers. In this review, we discuss existing and forthcoming devices designed to measure activity, heart rate, heart rhythm, and thoracic fluid. We also offer several frameworks to classify and better understand wearable devices, such that we may weigh their potential benefit in improving healthcare with the many challenges that must be addressed to reap these benefits.
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Affiliation(s)
- Joshua M Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kade Birkeland
- Cedars-Sinai Medical Delivery Network, Cedars-Sinai Health System, Los Angeles, CA
| | - Raymond Zimmer
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yaron Elad
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA; Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ilan Kedan
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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25
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Smeets CJ, Vranken J, Van der Auwera J, Verbrugge FH, Mullens W, Dupont M, Grieten L, De Cannière H, Lanssens D, Vandenberk T, Storms V, Thijs IM, Vandervoort PM. Bioimpedance Alerts from Cardiovascular Implantable Electronic Devices: Observational Study of Diagnostic Relevance and Clinical Outcomes. J Med Internet Res 2017; 19:e393. [PMID: 29170147 PMCID: PMC5721261 DOI: 10.2196/jmir.8066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/21/2017] [Accepted: 10/11/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices is expanding in the treatment of heart failure. Most of the current devices are equipped with remote monitoring functions, including bioimpedance for fluid status monitoring. The question remains whether bioimpedance measurements positively impact clinical outcome. OBJECTIVE The aim of this study was to provide a comprehensive overview of the clinical interventions taken based on remote bioimpedance monitoring alerts and their impact on clinical outcome. METHODS This is a single-center observational study of consecutive ICD and CRT patients (n=282) participating in protocol-driven remote follow-up. Bioimpedance alerts were analyzed with subsequently triggered interventions. RESULTS A total of 55.0% (155/282) of patients had an ICD or CRT device equipped with a remote bioimpedance algorithm. During 34 (SD 12) months of follow-up, 1751 remote monitoring alarm notifications were received (2.2 per patient-year of follow-up), comprising 2096 unique alerts (2.6 per patient-year of follow-up). Since 591 (28.2%) of all incoming alerts were bioimpedance-related, patients with an ICD or CRT including a bioimpedance algorithm had significantly more alerts (3.4 versus 1.8 alerts per patient-year of follow-up, P<.001). Bioimpedance-only alerts resulted in a phone contact in 91.0% (498/547) of cases, which triggered an actual intervention in 15.9% (87/547) of cases, since in 75.1% (411/547) of cases reenforcing heart failure education sufficed. Overall survival was lower in patients with a cardiovascular implantable electronic device with a bioimpedance algorithm; however, this difference was driven by differences in baseline characteristics (adjusted hazard ratio of 2.118, 95% CI 0.845-5.791). No significant differences between both groups were observed in terms of the number of follow-up visits in the outpatient heart failure clinic, the number of hospital admissions with a primary diagnosis of heart failure, or mean length of hospital stay. CONCLUSIONS Bioimpedance-only alerts constituted a substantial amount of incoming alerts when turned on during remote follow-up and triggered an additional intervention in only 16% of cases since in 75% of cases, providing general heart failure education sufficed. The high frequency of heart failure education that was provided could have contributed to fewer heart failure-related hospitalizations despite significant differences in baseline characteristics.
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Affiliation(s)
- Christophe Jp Smeets
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Julie Vranken
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jo Van der Auwera
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Hélène De Cannière
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dorien Lanssens
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Pieter M Vandervoort
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
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26
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Thakur PH, An Q, Swanson L, Zhang Y, Gardner RS. Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device. ESC Heart Fail 2017; 4:605-613. [PMID: 29154421 PMCID: PMC5695191 DOI: 10.1002/ehf2.12171] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to evaluate the haemodynamic correlates of heart sound (HS) parameters such as third HS (S3), first HS (S1), and HS-based systolic time intervals (HSTIs) from an implantable cardiac device. METHODS AND RESULTS Two unique animal models (10 swine with myocardial ischaemia and 11 canines with pulmonary oedema) were used to evaluate haemodynamic correlates of S1, S3, and HSTIs, namely, HS-based pre-ejection period (HSPEP), HS-based ejection time (HSET), and the ratio HSPEP/HSET during acute haemodynamic perturbations. The HS was measured using implanted cardiac resynchronization therapy defibrillator devices simultaneously with haemodynamic references such as left atrial (LA) pressure and left ventricular (LV) pressure. In the ischaemia model, S1 amplitude (r = 0.76 ± 0.038; P = 0.002), HSPEP (r = -0.56 ± 0.07; P = 0.002), and HSPEP/HSET (r = -0.42 ± 0.1; P = 0.002) were significantly correlated with LV dP/dtmax . In contrast, HSET was poorly correlated with LV dP/dtmax (r = 0.14 ± 0.14; P = 0.23). In the oedema model, a physiological delayed response was observed in S3 amplitude after acute haemodynamic perturbations. After adjusting for the delay, S3 amplitude significantly correlated with LA pressure in individual animals (r = 0.71 ± 0.07; max: 0.92; min: 0.17) as well as in aggregate (r = 0.62; P < 0.001). The S3 amplitude was able to detect elevated LA pressure, defined as >25 mmHg, with a sensitivity = 58% and specificity = 90%. CONCLUSIONS The HS parameters such as S1, S3, and HSTIs measured using implantable devices significantly correlated with haemodynamic changes in acute animal models, suggesting potential utility for remote heart failure patient monitoring.
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Affiliation(s)
| | - Qi An
- Boston Scientific, St Paul, Minnesota, USA
| | | | - Yi Zhang
- Boston Scientific, St Paul, Minnesota, USA
| | - Roy S Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
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Ono M, Varma N. Remote monitoring to Improve long-term prognosis in heart failure patients with implantable cardioverter-defibrillators. Expert Rev Med Devices 2017; 14:335-342. [PMID: 28299956 DOI: 10.1080/17434440.2017.1306438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Strong evidence exists for the utility of remote monitoring in cardiac implantable electronic devices for early detection of arrhythmias and evaluation of system performance. The application of remote monitoring for the management of chronic disease such as heart failure has been an active area of research. Areas covered: This review aims to cover the latest evidence of remote monitoring of implantable cardiac defibrillators in terms of heart failure prognosis. This article also updates the current technology relating to the method and discusses key factors to be addressed in order to better use the approach. PubMed and internet searches were conducted to acquire most recent data and technology information. Expert commentary: Multiparameter monitoring with automatic transmission is useful for heart failure management. Improved adherence to remote monitoring and an optimal algorithm for transmitted alerts and their management are warranted in the management of heart failure.
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Affiliation(s)
- Maki Ono
- a Department of Cardiology , Kameda General Hospital , Chiba , Japan
| | - Niraj Varma
- b Heart and Vascular Institute, J2-2 Cardiac Pacing and Electrophysiology, Cleveland Clinic , Cleveland , OH , USA
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Amir O, Ben-Gal T, Weinstein JM, Schliamser J, Burkhoff D, Abbo A, Abraham WT. Evaluation of remote dielectric sensing (ReDS) technology-guided therapy for decreasing heart failure re-hospitalizations. Int J Cardiol 2017; 240:279-284. [PMID: 28341372 DOI: 10.1016/j.ijcard.2017.02.120] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/12/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We tested whether remote dielectric sensing (ReDS)-directed fluid management reduces readmissions in patients recently hospitalized for heart failure (HF). BACKGROUND Pulmonary congestion is the most common cause of worsening HF leading to hospitalization. Accurate remote monitoring of lung fluid volume may guide optimal treatment and prevent re-hospitalization. ReDS technology is a quantitative non-invasive method for measuring absolute lung fluid volume. METHODS Patients hospitalized for acute decompensated HF were enrolled during their index admission and followed at home for 90days post-discharge. Daily ReDS readings were obtained using a wearable vest, and were used as a guide to optimizing HF therapy, with a goal of maintaining normal lung fluid content. Comparisons of the number of HF hospitalizations during ReDS-guided HF therapy were made, both to the 90days prior to enrollment and to the 90days following discontinuation of ReDS monitoring. RESULTS Fifty patients were enrolled, discharged, and followed at home for 76.9±26.2days. Patients were 73.8±10.3years old, 40% had LVEF above 40%, and 38% were women. Compared to the pre- and post-ReDS periods, there were 87% and 79% reductions in the rate of HF hospitalizations, respectively, during ReDS-guided HF therapy. The hazard ratio between the ReDS and the pre-ReDS period was 0.07 (95% CI [0.01-0.54] p=0.01), and between the ReDS and the post-ReDS period was 0.11 (95% CI [0.014-0.88] p=0.037). CONCLUSIONS These findings suggest that ReDS-guided management has the potential to reduce HF readmissions in acute decompensated HF patients recently discharged from the hospital.
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Affiliation(s)
- Offer Amir
- Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Israel; Faculty of Medicine in the Galilee, Bar Ilan University, Tiberias, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Aharon Abbo
- Sensible Medical Innovations Ltd., Netanya, Israel
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, OH, USA.
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A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices. JACC-HEART FAILURE 2017; 5:216-225. [DOI: 10.1016/j.jchf.2016.12.011] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/10/2016] [Accepted: 12/14/2016] [Indexed: 12/14/2022]
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Suzuki H, Nodera M, Kamioka M, Kaneshiro T, Kamiyama Y, Takeishi Y. Intracardiac impedance after cardiac resynchronization therapy is a novel predictor for worsening of heart failure. Heart Vessels 2017; 32:926-931. [DOI: 10.1007/s00380-017-0953-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/20/2017] [Indexed: 01/07/2023]
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Burri H. Is There a Future for Remote Cardiac Implantable Electronic Device Management? Arrhythm Electrophysiol Rev 2017; 6:109-110. [PMID: 29018516 DOI: 10.15420/aer.2017:10:1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the era of communication technology, remote monitoring has been a paradigm shift in the way patients with cardiac implantable electronic devices are managed. It has been endorsed by scientific societies and is being increasingly adopted in the clinical setting. Despite the various advantages associated with this strategy, data on improved clinical outcome are still sparse. The recently published study on the remote management of heart failure using implanted devices and formalised follow-up procedures, which turned out to be negative, has cast doubt on whether remote monitoring should still be used. This article provides a critical appraisal of the study, and discusses the issue of remote data management.
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Affiliation(s)
- Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
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32
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Saporito S, Dovancescu S, Herold IHF, van den Bosch HCM, van Assen HC, Aarts RM, Korsten HHM, Mischi M. Comparison of cardiac magnetic resonance imaging and bio-impedance spectroscopy for the assessment of fluid displacement induced by external leg compression. Physiol Meas 2016; 38:15-32. [DOI: 10.1088/1361-6579/38/1/15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Amir O, Azzam ZS, Gaspar T, Faranesh-Abboud S, Andria N, Burkhoff D, Abbo A, Abraham WT. Validation of remote dielectric sensing (ReDS™) technology for quantification of lung fluid status: Comparison to high resolution chest computed tomography in patients with and without acute heart failure. Int J Cardiol 2016; 221:841-6. [DOI: 10.1016/j.ijcard.2016.06.323] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/29/2022]
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Cuba Gyllensten I, Bonomi AG, Goode KM, Reiter H, Habetha J, Amft O, Cleland JG. Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance. JMIR Med Inform 2016; 4:e3. [PMID: 26892844 PMCID: PMC4777885 DOI: 10.2196/medinform.4842] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/09/2015] [Accepted: 10/07/2015] [Indexed: 12/25/2022] Open
Abstract
Background Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation.
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Domenichini G, Rahneva T, Diab IG, Dhillon OS, Campbell NG, Finlay MC, Baker V, Hunter RJ, Earley MJ, Schilling RJ. The lung impedance monitoring in treatment of chronic heart failure (the LIMIT-CHF study). Europace 2015; 18:428-35. [DOI: 10.1093/europace/euv293] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/03/2015] [Indexed: 12/13/2022] Open
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Hernandez GA, Navas V, Chaparro S. Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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Platz E, Jhund PS, Campbell RT, McMurray JJ. Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review. Eur J Heart Fail 2015; 17:906-16. [PMID: 26230356 DOI: 10.1002/ejhf.321] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/06/2015] [Accepted: 06/12/2015] [Indexed: 01/01/2023] Open
Abstract
AIMS Pulmonary oedema is a common and important finding in acute heart failure (AHF). We conducted a systematic review to describe the methods used to assess pulmonary oedema in recent randomized AHF trials and report its prevalence in these trials. METHODS AND RESULTS Of 23 AHF trials published between 2002 and 2013, six were excluded because they were very small or not randomized, or missing full-length publications. Of the remaining 17 (n = 200-7141) trials, six enrolled patients with HF and reduced ejection fraction (HF-REF) and 11, patients with both HF-REF and HF with preserved ejection fraction (HF-PEF). Pulmonary oedema was an essential inclusion criterion, in most trials, based upon findings on physical examination ('rales'), radiographic criteria ('signs of congestion'), or both. The prevalence of pulmonary oedema in HF-REF trials ranged from 75% to 83% and in combined HF-REF and HF-PEF trials from 51% to 100%. Five trials did not report the prevalence or extent of pulmonary oedema assessed by either clinical examination or chest x-ray. Improvement of pulmonary congestion with treatment was inconsistently reported and commonly grouped with other signs of congestion into a score. One trial suggested that patients with rales over >2/3 of the lung fields on admission were at higher risk of adverse outcomes than those without. CONCLUSION Although pulmonary oedema is a common finding in AHF, represents a therapeutic target, and may be of prognostic importance, recent trials used inconsistent criteria to define it, and did not consistently report its severity at baseline or its response to treatment. Consistent and ideally quantitative, methods for the assessment of pulmonary oedema in AHF trials are needed.
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Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ross T Campbell
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John J McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Banchs JE, Scher DL. Emerging role of digital technology and remote monitoring in the care of cardiac patients. Med Clin North Am 2015; 99:877-96. [PMID: 26042888 DOI: 10.1016/j.mcna.2015.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Current available mobile health technologies make possible earlier diagnosis and long-term monitoring of patients with cardiovascular diseases. Remote monitoring of patients with implantable devices and chronic diseases has resulted in better outcomes reducing health care costs and hospital admissions. New care models, which shift point of care to the outpatient setting and the patient's home, necessitate innovations in technology.
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Affiliation(s)
- Javier E Banchs
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, 2401 South 31st Street, Temple, TX 76508, USA.
| | - David Lee Scher
- Department of Medicine, Division of Cardiology, Penn State Hershey Heart & Vascular Institute, 500 University Drive, H047, Hershey, PA 17033, USA
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