Implantação de dispositivos de ressincronização e/ou desfibrilhação em doentes com insuficiência cardíaca: dados da vida real ‐ o Estudo Síncrone

Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information.

PURPOSE

To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app).

METHODS

In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated.

RESULTS

A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III-IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1-13) to 42.2% (weeks_40-52, p < 0.001).

CONCLUSIONS

High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.

Beyond Simpson's Rule: Accounting for Orientation and Ellipticity Assumptions

Simpson's biplane rule (SBR) is considered the gold standard method for left ventricle (LV) volume quantification from echocardiography but relies on a summation-of-disks approach that makes assumptions about LV orientation and cross-sectional shape. We aim to identify key limiting factors in SBR and to develop a new robust standard for volume quantification. Three methods for computing LV volume were studied: (i) SBR, (ii) addition of a truncated basal cone (TBC) to SBR and (iii) a novel method of basal-oriented disks (BODs). Three retrospective cohorts representative of the young, adult healthy and heart failure populations were used to study the impact of anatomical variations in volume computations. Results reveal how basal slanting can cause over- and underestimation of volume, with errors by SBR and TBC >10 mL for slanting angles >6°. Only the BOD method correctly accounted for basal slanting, reducing relative volume errors by SBR from -2.23 ± 2.21% to -0.70 ± 1.91% in the adult population and similar qualitative performance in the other two cohorts. In conclusion, the summation of basal oriented disks, a novel interpretation of SBR, is a more accurate and precise method for estimating LV volume.