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Mahalwar G, Kumar A, Kalra A. Virtual Cardiology: Past, Present, Future Directions, and Considerations. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:117-122. [PMID: 37305213 PMCID: PMC10225773 DOI: 10.1007/s12170-023-00719-0] [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: 03/22/2023] [Indexed: 06/13/2023]
Abstract
Purpose of Review Through this review, we attempt to explore the role of telemedicine and virtual visits in the field of cardiology pre-COVID-19 and during COVID-19 pandemic, their limitations and their future scope for delivery of care. Recent Findings Telemedicine, which rose to prominence during COVID-19 pandemic, helped not only in reducing the burden on the healthcare system during a time of crisis but also in improving patient outcomes. Patients and physicians also favored virtual visits when feasible. Virtual visits were found to have the potential to be continued beyond the pandemic and play a significant role in patient care alongside conventional face-to-face visits. Summary Although tele-cardiology has proven beneficial in terms of patient care, convenience, and access, it comes with its fair share of limitations-both logistical and medical. Whilst there remains a great scope for improvement in the quality of patient care provided through telemedicine, it has shown the potential to become an integral part of medical practice in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s12170-023-00719-0.
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Affiliation(s)
- Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ankur Kalra
- Franciscan Physician Network Cardiology, Franciscan Health, 3900 St. Francis Way, Suite 200 Lafayette, IN 47905 Lafayette, USA
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Ezer P, Farkas N, Szokodi I, Kónyi A. Automatic daily remote monitoring in heart failure patients implanted with a cardiac resynchronisation therapy-defibrillator: a single-centre observational pilot study. Arch Med Sci 2023; 19:73-85. [PMID: 36817653 PMCID: PMC9897079 DOI: 10.5114/aoms/131958] [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: 09/11/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The impact of remote monitoring (RM) on clinical outcomes in heart failure (HF) patients with cardiac resynchronisation therapy-defibrillator (CRT-D) implantation is controversial. This study sought to evaluate the performance of an RM follow-up protocol using modified criteria of the PARTNERS HF trial in comparison with a conventional follow-up scheme. MATERIAL AND METHODS We compared cardiovascular (CV) mortality (primary endpoint) and hospitalisation events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted patients with automatic RM utilising daily transmissions (RM group, n = 45) and conventional follow-up (CFU group, n = 43) in a single-centre observational study. RESULTS After a median follow-up of 25 months, a significant advantage was seen in the RM group in terms of CV mortality (1 vs. 6 death event, p = 0.04), although RM follow-up was not an independent predictor for CV mortality (HR = 0.882; 95% CI: 0.25-3.09; p = 0.845). Patient CV mortality was independently influenced by hospitalisation events for decompensated HF (HR = 3.24; 95% CI: 8-84; p = 0.022) during follow-up. We observed significantly fewer hospitalisation events for decompensated HF (8 vs. 29 events, p = 0.046) in the RM group. Furthermore, a decreased number of total (161 vs. 263, p < 0.01) and unnecessary ambulatory in-office visits (6 vs. 19, p = 0.012) were seen in the RM group as compared to the CFU group. CONCLUSIONS Follow-up of CRT-D patients using automatic RM with daily transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival. Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional follow-up.
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Affiliation(s)
- Peter Ezer
- Heart Institute, University of Pécs, Medical School, Foreign Medical Sciences, Hungary
| | - Nelli Farkas
- Bioanalytical Institute, University of Pécs, Medical School, Pecs, Hungary
| | - István Szokodi
- Heart Institute, University of Pécs, Medical School, Foreign Medical Sciences, Hungary
- Szentagothai Research Centre, University of Pécs, Pecs, Hungary
| | - Attila Kónyi
- Heart Institute, University of Pécs, Medical School, Foreign Medical Sciences, Hungary
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3
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Mahajan D, Frost K, Herrmann K, McGee-Taylor R. Real-world Characterization and Use of Insertable Cardiac Monitor Remote Programming. J Innov Card Rhythm Manag 2022; 13:5230-5235. [PMID: 36570481 PMCID: PMC9721296 DOI: 10.19102/icrm.2022.13112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 12/27/2022] Open
Abstract
Remote device programming may enable workflow efficiencies and reduce resource strains on clinics as well as patients. Although the remote patient management ecosystem has evolved, several challenges remain, and the role of remote device programming for an insertable cardiac monitor (ICM) has yet to be described in a real-world setting. The purpose of this study was to characterize the initial real-world use of remote programming of an ICM. The cohort included 8,238 patients with the LUX-Dx™ ICM (Boston Scientific, Marlborough, MA, USA) during the first year of commercial use, which is also the first year that remote programming was available for an ICM. A descriptive review of reprogramming events revealed that 24% of devices were reprogrammed and that 82% of all reprogramming events occurred remotely. Over 74% of first reprogramming events occurred within the first 30 days following device insertion, and nearly 80% of devices only had 1 reprogramming event. These early data support the hypothesis that remote programming of an ICM is a clinically useful tool that may improve the clinical experience of device programming optimization, especially within the first month following device insertion.
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Affiliation(s)
- Deepa Mahajan
- Boston Scientific, St. Paul, MN, USA,Address correspondence to: Deepa Mahajan, PhD, Boston Scientific, 4100 Hamline Ave N., Arden Hills, St. Paul, MN 55112, USA.
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Merdler I, Hochstadt A, Ghantous E, Lupu L, Borohovitz A, Zahler D, Taieb P, Sadeh B, Zalevsky Z, Garcia-Monreal J, Shergei M, Shatsky M, Beck Y, Polani S, Arbel Y. A Contact-Free Optical Device for the Detection of Pulmonary Congestion-A Pilot Study. BIOSENSORS 2022; 12:833. [PMID: 36290968 PMCID: PMC9599847 DOI: 10.3390/bios12100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The cost of heart failure hospitalizations in the US alone is over USD 10 billion per year. Over 4 million Americans are hospitalized every year due to heart failure (HF), with a median length of stay of 4 days and an in-hospital mortality rate that exceeds 5%. Hospitalizations of patients with HF can be prevented by early detection of lung congestion. Our study assessed a new contact-free optical medical device used for the early detection of lung congestion. METHODS The Gili system is an FDA-cleared device used for measuring chest motion vibration data. Lung congestion in the study was assessed clinically and verified via two cardiologists. An algorithm was developed using machine learning techniques, and cross-validation of the findings was performed to estimate the accuracy of the algorithm. RESULTS A total of 227 patients were recruited (101 cases vs. 126 controls). The sensitivity and specificity for the device in our study were 0.91 (95% CI: 0.86-0.93) and 0.91 (95% CI: 0.87-0.94), respectively. In all instances, the observed estimates of PPVs and NPVs were at least 0.82 and 0.90, respectively. The accuracy of the algorithm was not affected by different covariates (including respiratory or valvular conditions). CONCLUSIONS This study demonstrates the efficacy of a contact-free optical device for detecting lung congestion. Further validation of the study results across a larger and precise scale is warranted.
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Affiliation(s)
- Ilan Merdler
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ariel Borohovitz
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Zeev Zalevsky
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
- Faculty of Engineering, Bar-Ilan University, Ramat Gan 52900, Israel
| | - Javier Garcia-Monreal
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
- Department of Optics, University of Valencia, 46003 Valencia, Spain
| | - Michael Shergei
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
| | - Maxim Shatsky
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
| | - Yoav Beck
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
| | - Sagi Polani
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Tel-Aviv University, Tel Aviv 69978, Israel
- Donisi Health, Formerly Contin Use Biometrics Ltd., Tel Aviv 69978, Israel
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5
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Ezer P, Gergics M, Szokodi I, Kónyi A. Impact of remote monitoring in heart failure patients with cardiac implantable electronic devices during COVID-19 pandemic: a single center experience. J Cardiothorac Surg 2022; 17:213. [PMID: 36031607 PMCID: PMC9420183 DOI: 10.1186/s13019-022-01963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions. METHODS Patients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups. RESULTS No significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672). In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients. CONCLUSIONS Specified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.
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Affiliation(s)
- Péter Ezer
- Heart Institute of the Clinical Center University of Pécs, University of Pécs Medical School, Ifjuság Street 13, Pecs, 7621 Hungary
| | - Marin Gergics
- 1st Department of Medicine of Clinical Center University of Pécs, University of Pécs Medical School, Ifjusag ut 13, 7621 Pecs, Hungary
| | - István Szokodi
- Heart Institute of the Clinical Center University of Pécs, University of Pécs Medical School, Ifjuság Street 13, Pecs, 7621 Hungary
- Szentágothai Research Center, University of Pécs, Ifjusag ut 13, Pecs, 7621 Hungary
| | - Attila Kónyi
- Heart Institute of the Clinical Center University of Pécs, University of Pécs Medical School, Ifjuság Street 13, Pecs, 7621 Hungary
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Perl L, Meerkin D, D'amario D, Avraham BB, Gal TB, Weitsman T, Hasin T, Ince H, Feickert S, D'ancona G, Schaefer U, Sievert H, Leyva F, Whinnett ZI, Di Mario C, Jonas M, Glikson M, Habib M, Caspi O, Koren O, Abraham WT, Kornowski R, Crea F. The V-LAP System for Remote Left Atrial Pressure Monitoring of Patients with Heart Failure: Remote Left Atrial Pressure Monitoring. J Card Fail 2022; 28:963-972. [PMID: 35041933 DOI: 10.1016/j.cardfail.2021.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients with heart failure (HF) are at an increased risk of hospital admissions. The aim of this report is to describe the feasibility, safety and accuracy of a novel wireless left atrial pressure (LAP) monitoring system in HF patients. METHODS The V-LAP Left Atrium Monitoring systEm for Patients With Chronic sysTOlic & Diastolic Congestive heart Failure (VECTOR-HF) study is a prospective, multicenter, single-arm, open-label, first-in human clinical trial to assess the safety, performance and usability of the V-LAP system (Vectorious Medical Technologies, Ltd) in NYHA Class III HF patients. The device was implanted in the inter-atrial septum via a percutaneous, trans-septal approach, guided by fluoroscopy and echocardiography. Primary endpoints included the successful deployment of the implant, ability to perform initial pressure measurements and safety outcomes. RESULTS To date, 24 patients were implanted with the LAP monitoring device. No device-related complications have occurred. LAP was reported accurately, agreeing well with wedge pressure at 3 months (Lin's CCC=0.850). After 6 months, NYHA class improved in 40% of the patients (95% CI =16.4%-63.5%), while 6-minute walk test distance had not changed significantly (313.9 ± 144.9 vs. 232.5 ± 129.9 meters, p=0.076). CONCLUSION The V-LAP left atrium monitoring system appears to be safe and accurate.
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Affiliation(s)
- Leor Perl
- Cardiology Department, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel.
| | - David Meerkin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Binyamin Ben Avraham
- Cardiology Department, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel
| | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel
| | - Tatyana Weitsman
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, 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, Ernst-Heydemann-Straße 6, Rostock, Germany
| | - Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University, Medical Center, Ernst-Heydemann-Straße 6, Rostock, Germany
| | - Giuseppe D'ancona
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University, Medical Center, Ernst-Heydemann-Straße 6, Rostock, Germany
| | - Ulrich Schaefer
- Department of Cardiology, Angiology and Intensive Care Medicine, Marienhospital, Hamburg, Germany
| | | | - Francisco Leyva
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Experimental & Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Manhal Habib
- Departments of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - Oren Caspi
- Departments of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - Oran Koren
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Mapelli M, Vignati C, Gugliandolo P, Fumagalli D, Agostoni P. Feasibility of remote home monitoring with a T-shirt wearable device in post-recovery COVID-19 patients. J Cardiovasc Med (Hagerstown) 2021; 22:860-863. [PMID: 34534155 DOI: 10.2459/jcm.0000000000001165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan
| | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan
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Remote monitoring for heart failure using implantable devices: a systematic review, meta-analysis, and meta-regression of randomized controlled trials. Heart Fail Rev 2021; 27:1281-1300. [PMID: 34559368 PMCID: PMC8460850 DOI: 10.1007/s10741-021-10150-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
In heart failure (HF) patients, remote monitoring using implantable devices may be used to predict and reduce HF exacerbations and mortality. Data from randomized controlled trials (RCTs) was assessed to determine the effectiveness of implantable remote monitoring on the improvement of outcomes in HF patients. A systematic review and meta-analysis of RCTs testing remote monitoring versus standard of care for management of HF patients was performed. Primary endpoints were all-cause mortality and a composite of cardiovascular (CV) and HF hospitalizations. Rate ratios (RRs) and 95% confidence intervals (CI) were calculated. A secondary analysis tested for heterogeneity of treatment effect (HTE) comparing right ventricular/pulmonary pressure monitoring versus impedance-based monitoring on hospitalization. A regression analysis was performed using the mean follow-up time as the moderator on each primary endpoint. Eleven RCTs (n = 6196) were identified with a mean follow-up of 21.9 months. The mean age and reported ejection fraction were 64.1 years and 27.7%, respectively. Remote monitoring did not reduce mortality (RR 0.89 [95% CI 0.77, 1.03]) or the composite of CV and HF hospitalizations (RR 0.98 [0.81, 1.19]). Subgroup analysis found significant HTE for hospitalizations between those studies that used right ventricular/pulmonary pressure monitoring versus impedance-based monitoring (I2 = 87.1%, chi2 = 7.75, p = 0.005). Regression analysis found no relationship between the log rate ratio of remote monitoring’s effect on mortality, CV hospitalization or HF hospitalization, and mean follow-up time. Compared to standard of care, remote monitoring using implantable devices did not reduce mortality, CV, or HF hospitalizations. However, right ventricular/pulmonary pressure monitoring may reduce HF hospitalizations, which will need to be explored in future studies.
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Bhatt AS, Adler ED, Albert NM, Anyanwu A, Bhadelia N, Cooper LT, Correa A, Defilippis EM, Joyce E, Sauer AJ, Solomon SD, Vardeny O, Yancy C, Lala A. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. J Card Fail 2021; 28:93-112. [PMID: 34481067 PMCID: PMC8408888 DOI: 10.1016/j.cardfail.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric D Adler
- Department of Cardiology, University of California, San Diego, California
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute; Cleveland Clinic, Cleveland, Ohio
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nahid Bhadelia
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; Center for Emerging Infectious Diseases Policy and Research (CEID), Boston University, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, and School of Medicine, University College Dublin, Ireland
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Gardner RS, Capodilupo RC, Ahmed R, Stolen CM, An Q, Averina V, Hernandez AF, Boehmer JP. Multiparameter diagnostic sensor measurements in heart failure patients presenting with SARS-CoV-2 infection. ESC Heart Fail 2021; 8:4026-4036. [PMID: 34184428 PMCID: PMC8426935 DOI: 10.1002/ehf2.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022] Open
Abstract
Aims Implantable device‐based sensor measurements including heart sounds, markers of ventilation, and thoracic impedance have been shown to predict heart failure (HF) hospitalizations. We sought to assess how these parameters changed prior to COVID‐19 (Cov‐19) and how these compared with those presenting with decompensated HF or pneumonia. Methods and results This retrospective analysis explores patterns of changes in daily measurements by implantable sensors in 10 patients with Cov‐19 and compares these findings with those observed prior to HF (n = 88) and pneumonia (n = 12) hospitalizations from the MultiSENSE, PREEMPT‐HF, and MANAGE‐HF trials. The earliest sensor changes prior to Cov‐19 were observed in respiratory rate (6 days) and temperature (5 days). There was a three‐fold to four‐fold greater increase in respiratory rate, rapid shallow breathing index, and night heart rate compared with those presenting with HF or pneumonia. Furthermore, activity levels fell more in those presenting with Cov‐19, a change that was often sustained for some time. In contrast, there were no significant changes in 1st or 3rd heart sound (S1 and S3) amplitude in those presenting with Cov‐19 or pneumonia compared with the known changes that occur in HF decompensation. Conclusions Multi‐sensor device diagnostics may provide early detection of Cov‐19, distinguishable from worsening HF by an extreme and fast rise in respiratory rate along with no changes in S3.
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Affiliation(s)
- Roy S Gardner
- Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Robert C Capodilupo
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, NH, USA
| | | | | | - Qi An
- Boston Scientific, Arden Hills, MN, USA
| | | | | | - John P Boehmer
- Penn State Milton S Hershey Medical Center, Hershey, PA, USA
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11
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Bueno H, Moura B, Lancellotti P, Bauersachs J. The year in cardiovascular medicine 2020: heart failure and cardiomyopathies. Eur Heart J 2021; 42:657-670. [PMID: 33388764 DOI: 10.1093/eurheartj/ehaa1061] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Héctor Bueno
- Multidisciplinary Translational Cardiovascular Research Group. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, Madrid 28029, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Brenda Moura
- Cardiology Department, Military Hospital, Av. da Boavista S/N, 4050-115 Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L'Hôpital 1, 4000 Liège, Belgium.,Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola Bari, Italy and Via Corriera, 1, 48033 Cotignola RA, Italy and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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12
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Jiang X, Yao J, You JHS. Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis. J Med Internet Res 2021; 23:e26516. [PMID: 33656440 PMCID: PMC7931824 DOI: 10.2196/26516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.
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Affiliation(s)
- Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiaqi Yao
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joyce Hoi-Sze You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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13
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Baginski BN, Byrne KA, Vaz DG, Barber R, Blackhurst D, Tibbett TP, Guichard JL. Development and implementation of a remote patient monitoring program for heart failure: a single-centre experience. ESC Heart Fail 2021; 8:1349-1358. [PMID: 33503681 PMCID: PMC8006699 DOI: 10.1002/ehf2.13214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/09/2020] [Accepted: 01/02/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Remote patient monitoring (RPM) in the management of heart failure (HF), including telemonitoring, thoracic impedance, implantable pulmonary artery pressure (PAP) monitors, and cardiac implantable electronic device (CIED)‐based sensors, has had varying outcomes in single platform studies. Uncertainty remains regarding the development of single‐centre RPM programs; additionally, no studies examine the effectiveness of dual platform RPM programs for HF. This study describes the implementation and outcomes of a dual platform RPM program for HF at a single centre. Methods and results An RPM program was developed to include two platforms (e.g. CardioMEMS™ HF System and HeartLogic™ HF Diagnostic). To examine changes within each participant over time, study‐related outcomes including total hospitalizations (TH), total length of stay (TLOS), cardiac hospitalizations (CH), cardiac LOS (CLOS), and cardiac‐related emergency department (ED) visits were compared in two timeframes: 12 months pre‐enrolment and post‐enrolment into RPM. For 141 participants enrolled, there was a significant reduction in the likelihood of experiencing a CH by 19% (0.77 vs. 0.61 events/patient‐year; HR: 0.81, 95% CI: 0.67–0.97, P = 0.03) and a cardiac‐related ED visit by 28% (0.48 vs. 0.34 events/patient‐year; HR: 0.72, 95% CI: 0.55–0.93, P = 0.01). There was also a 51% decrease (SE = 1.41, 95% CI: 2.79–8.38 days, P < 0.001) and 62% decrease (SE = 1.24, 95% CI: 3.35–8.22 days, P < 0.001) in TLOS and CLOS, respectively. Conclusions A dual platform RPM program for HF using structured education, RPM‐capable devices, and alert‐specific medication titration reduces the likelihood of experiencing a cardiac hospitalization and cardiac‐related ED visit in this single‐centre study.
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Affiliation(s)
- Bryana N Baginski
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Dev G Vaz
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, 1005 Grove Road, Greenville, SC, 29605, USA
| | - Regina Barber
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, 1005 Grove Road, Greenville, SC, 29605, USA
| | - Dawn Blackhurst
- Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA
| | - Thomas P Tibbett
- Department of Data Science, Southern Methodist University, Dallas, TX, USA
| | - Jason L Guichard
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical Circulatory Support, Prisma Health-Upstate, 1005 Grove Road, Greenville, SC, 29605, USA
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14
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Sankaranarayanan R, Hartshorne-Evans N, Redmond-Lyon S, Wilson J, Essa H, Gray A, Clayton L, Barton C, Ahmed FZ, Cunnington C, Satchithananda DK, Murphy CL. The impact of COVID-19 on the management of heart failure: a United Kingdom patient questionnaire study. ESC Heart Fail 2021; 8:1324-1332. [PMID: 33463044 PMCID: PMC8006619 DOI: 10.1002/ehf2.13209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022] Open
Abstract
Aims The coronavirus disease 2019 (COVID‐19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID‐19 upon HF services. Methods and results The survey was conducted by the Pumping Marvellous Foundation, a UK HF patient charity. ‘Survey Monkey’ was used to disseminate the questionnaire in the Pumping Marvellous Foundation 's online patient group and in 10 UK hospitals (outpatient hospital and community HF clinics). There were 1050 responses collected (693/1050—66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID‐19 (mean 7 ± 2.5 on anxiety scale of 0 to 10) compared with anxiety regarding HF (6.1 ± 2.4; P < 0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3 ± 2.2 vs. 5.9 ± 2.5 in those aged >60 years; P = 0.005) and COVID‐19 (7.3 ± 2.3 vs. 6.7 ± 2.6 those aged >60 years; P < 0.001). Sixty‐five per cent of respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. Thirty‐seven per cent reported disruption to medication prescription services, and Thirty‐four per cent reported inability to access their HF teams promptly. Thirty‐two per cent expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative, and 7% stated that they would not attend hospital at all). Conclusions The COVID‐19 pandemic has caused significant anxiety amongst HF patients regarding COVID‐19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription, and monitoring services were implicated as sources of anxiety.
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Affiliation(s)
- Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.,National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK
| | - Nick Hartshorne-Evans
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Sam Redmond-Lyon
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Jill Wilson
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.,National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK
| | - Alastair Gray
- Craigavon Area Hospital, Department of Cardiology, 68 Lurgan Rd, Portadown, Craigavon, BT63 5QQ, Northern Ireland, UK
| | - Louise Clayton
- British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.,Alliance for Heart Failure, London, UK.,Department of Cardiology, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Carys Barton
- British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK
| | - Fozia Z Ahmed
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Colin Cunnington
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | | | - Clare L Murphy
- NHS Greater Glasgow and Clyde Heart MCN Heart Failure subgroup, Scotland, UK.,Heart Failure Hub, Scotland, UK.,Department of Cardiology, Royal Alexandra and Vale of Leven Hospitals, Castlehead, Paisley, PA2 9PJ, Scotland, UK
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15
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Calò L, de Ruvo E, Martino AM, Prenner G, Manninger M, Scherr D. Trends beyond the new normal: from remote monitoring to digital connectivity. Eur Heart J Suppl 2021; 22:P8-P12. [PMID: 33390863 PMCID: PMC7757717 DOI: 10.1093/eurheartj/suaa170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
COVID pandemic emergency has forced changes from traditional in-person visits to application of telemedicine in order to overcome the barriers and to deliver care. COVID-19 has accelerated adoption of digital health. During this time, the distance is itself a prevention tool and the use of technology to deliver healthcare services and information has driven the discovery of mobile and connected health services. Health services should to be prepared to integrate the old model of remote monitoring of CIEDs and adopt new digital tools such as mobile Apps and connected sensors.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Ermenegildo de Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Anna Maria Martino
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Günther Prenner
- Clinical Department of Cardiology, University of Graz, Graz, Austria
| | - Martin Manninger
- Clinical Department of Cardiology, University of Graz, Graz, Austria
| | - Daniel Scherr
- Clinical Department of Cardiology, University of Graz, Graz, Austria
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16
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Bayes-Genis A, Codina P, Abdul-Jawad Altisent O, Santiago E, Domingo M, Cediel G, Spitaleri G, Lupón J. Advanced remote care for heart failure in times of COVID-19 using an implantable pulmonary artery pressure sensor: the new normal. Eur Heart J Suppl 2021; 22:P29-P32. [PMID: 33390867 PMCID: PMC7757718 DOI: 10.1093/eurheartj/suaa169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is a major public health problem and a leading cause of hospitalization in western countries. Over the past decades, the goal has been to find the best method for monitoring congestive symptoms to prevent hospitalizations. Addressing this task through regular physician visits, blood tests, and imaging has proven insufficient for optimal control and has not decreased enough HF-related hospitalization rates. In recent years, new devices have been developed for this reason and CardioMEMS is one of the therapeutic monitoring options. CardioMEMS has shown to be effective in preventing and reducing HF hospitalizations in patients both with HF with reduced ejection fraction and HF with preserved ejection fraction. CardioMEMS’ versatility has made it a great option for pulmonary artery pressure monitoring, both during the coronavirus disease-19 (COVID-19) pandemic and when the clinic visits have (partially) resumed. CardioMEMS is the remote haemodynamic monitoring system with the most evidence-driven efficacy, and COVID-19 has put it in the spot as a centre-stage technology for HF monitoring. In a few months of the COVID-19 epidemic, CardioMEMS has grown to maturity, making it the new normal for high-quality, high-value remote HF care.
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Codina
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Omar Abdul-Jawad Altisent
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Evelyn Santiago
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Domingo
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Giosafat Spitaleri
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Josep Lupón
- Heart Institute and Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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17
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Bhatt AS, Jering KS, Vaduganathan M, Claggett BL, Cunningham JW, Rosenthal N, Signorovitch J, Thune JJ, Vardeny O, Solomon SD. Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19. JACC. HEART FAILURE 2021; 9:65-73. [PMID: 33384064 PMCID: PMC7833294 DOI: 10.1016/j.jchf.2020.11.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karola S Jering
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Cunningham
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ning Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | | | - Jens J Thune
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans' Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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18
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Shumway JL, Stolen CM, Ahmed R, Plumer M, Capodilupo RC. Case Reports of Implantable Cardiac Device Physiologic Sensor Changes in Subjects with Coronavirus Disease-2019 Infection. J Card Fail 2020; 27:373-378. [PMID: 33385524 PMCID: PMC7837250 DOI: 10.1016/j.cardfail.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023]
Abstract
The severe acute respiratory syndrome novel coronavirus-2 pandemic has established a new set of challenges to health care delivery. Remotely monitored physiologic sensors on implantable cardiac devices can provide insight into the differential diagnosis of dyspnea in the heart failure population. We report on a unique pattern of sensor deviations that seem to occur specifically with severe acute respiratory syndrome novel coronavirus-2 infection.
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Affiliation(s)
- Jessica L Shumway
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
| | | | | | - Marie Plumer
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
| | - Robert C Capodilupo
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
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19
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Abstract
PURPOSE OF REVIEW Despite the promise of remote patient monitoring (RPM), this technology remained underutilized secondary to a lack of data transparency and systems issues until the COVID-19 pandemic ushered in a new era of telehealth and virtual solutions out of necessity. This review will explore the data supporting the use of RPM via both implantable and wearable devices in the field of cardiology and the role of home monitoring using RPM in the era of COVID-19. RECENT FINDINGS RPM using implantable cardiac devices is a safe alternative to in-person only visits which leads to enhanced patient satisfaction and improved clinical outcomes. Consumer-grade wearable sensors have drastically expanded RPM capabilities from just the sickest cardiac patients to the entire population aiding in early diagnosis and real-time disease management. Home monitoring enabled by automated alert systems tailored specifically to the needs of the patient by the provider will be the cornerstone of a more continuous, patent-centric healthcare model.
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Affiliation(s)
- Jennifer C. Miller
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Devin Skoll
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Leslie A. Saxon
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
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20
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Alvarez-Garcia J, Lee S, Gupta A, Cagliostro M, Joshi AA, Rivas-Lasarte M, Contreras J, Mitter SS, LaRocca G, Tlachi P, Brunjes D, Glicksberg BS, Levin MA, Nadkarni G, Fayad Z, Fuster V, Mancini D, Lala A. Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19. J Am Coll Cardiol 2020; 76:2334-2348. [PMID: 33129663 PMCID: PMC7598769 DOI: 10.1016/j.jacc.2020.09.549] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with pre-existing heart failure (HF) are likely at higher risk for adverse outcomes in coronavirus disease-2019 (COVID-19), but data on this population are sparse. OBJECTIVES This study described the clinical profile and associated outcomes among patients with HF hospitalized with COVID-19. METHODS This study conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at 1 of 5 Mount Sinai Health System hospitals in New York City between February 27 and June 26, 2020. Clinical characteristics and outcomes (length of stay, need for intensive care unit, mechanical ventilation, and in-hospital mortality) were captured from electronic health records. For patients identified as having a history of HF by International Classification of Diseases-9th and/or 10th Revisions codes, manual chart abstraction informed etiology, functional class, and left ventricular ejection fraction (LVEF). RESULTS Mean age was 63.5 years, and 45% were women. Compared with patients without HF, those with previous HF experienced longer length of stay (8 days vs. 6 days; p < 0.001), increased risk of mechanical ventilation (22.8% vs. 11.9%; adjusted odds ratio: 3.64; 95% confidence interval: 2.56 to 5.16; p < 0.001), and mortality (40.0% vs. 24.9%; adjusted odds ratio: 1.88; 95% confidence interval: 1.27 to 2.78; p = 0.002). Outcomes among patients with HF were similar, regardless of LVEF or renin-angiotensin-aldosterone inhibitor use. CONCLUSIONS History of HF was associated with higher risk of mechanical ventilation and mortality among patients hospitalized for COVID-19, regardless of LVEF.
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Affiliation(s)
- Jesus Alvarez-Garcia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain. https://twitter.com/j_alvarezgarcia
| | - Samuel Lee
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arjun Gupta
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew Cagliostro
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aditya A Joshi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mercedes Rivas-Lasarte
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Johanna Contreras
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sumeet S Mitter
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gina LaRocca
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pilar Tlachi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danielle Brunjes
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; The Mount Sinai Clinical Intelligence Center, New York, New York
| | - Matthew A Levin
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Girish Nadkarni
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; The Mount Sinai Clinical Intelligence Center, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi Fayad
- The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anuradha Lala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
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Mitter SS, Alvarez-Garcia J, Miller MA, Moss N, Lala A. Insights From HeartLogic Multisensor Monitoring During the COVID-19 Pandemic in New York City. JACC-HEART FAILURE 2020; 8:1053-1055. [PMID: 33272384 PMCID: PMC7553123 DOI: 10.1016/j.jchf.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
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