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Elsner C, Bettin S, Tilz R, Häckl D. Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure. Curr Heart Fail Rep 2024; 21:186-193. [PMID: 38662154 DOI: 10.1007/s11897-024-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a major public health problem worldwide, affecting more than 64 million people [1]. The complex and severe nature of HF presents challenges in providing cost-effective care as patients often require multiple hospitalizations and treatments. This review of relevant studies with focus on the last 10 years summarizes the health and economic implications of various HF treatment options in Europe and beyond. Although the main cost drivers in HF treatment are clinical (re)admission and decompensation of HF, an assessment of the economic impacts of various other device therapy options for HF care are included in this review. This includes: cardiovascular implantable electronic devices (CIEDs) such as cardiac-resynchronisation-therapy devices that include pacemaking (CRT-P), cardiac-resynchronisation-therapy devices that include defibrillation (CRT-D), implantable cardioverter/defibrillators (ICDs) and various types of pacemakers. The impact of (semi)automated (tele)monitoring as a relevant factor for increasing both the quality and economic impact of care is also taken into consideration. Quality of life adjusted life years (QALYs) are used in the overall context as a composite metric reflecting quantity and quality of life as a standardized measurement of incremental cost-effectiveness ratios (ICER) of different device-based HF interventions. RECENT FINDINGS In terms of the total cost of different devices, CRT-Ds were found in several studies to be more expensive than all other devices in regards to runtime and maintenance costs including (re)implantation. In the case of CRT combined with an implantable cardioverter-defibrillator (CRT-D) versus ICD alone, CRT-D was found to be the most cost-effective treatment in research work over the past 10 years. Further comparison between CRT-D vs. CRT-P does not show an economic advantage of CRT-D as a minority of patients require shock therapy. Furthermore, a positive health economic effect and higher survival rate is seen in CRT-P full ventricular stimulation vs. right heart only stimulation. Telemedical care has been found to provide a positive health economic impact for selected patient groups-even reducing patient mortality. For heart failure both in ICD and CRT-D subgroups the given telemonitoring benefit seems to be greater in higher-risk populations with a worse HF prognosis. In patients with HF, all CIED therapies are in the range of commonly accepted cost-effectiveness. QALY and ICER calculations provide a more nuanced understanding of the economic impact these therapies create in the healthcare landscape. For severe cases of HF, CRT-D with telemedical care seems to be the better option from a health economic standpoint, as therapy is more expensive, but costs per QALY range below the commonly accepted threshold.
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Affiliation(s)
- Christian Elsner
- Center for Artificial Intelligence, University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Simon Bettin
- Department for ENT, University of Lübeck, Lübeck, Germany
| | - Roland Tilz
- German Center for Cardiovascular Research (DZHK), Partner Site, Lübeck, Germany
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2
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Kagiyama N, Kasai T, Murata N, Yamakawa N, Tanaka Y, Hiki M, Inoue K, Sato A, Ishiwata S, Murata A, Shitara J, Kato T, Suda S, Matsue Y, Naito R, Minamino T, Yanagisawa N, Daida H. Feasibility of self-measurement telemonitoring using a handheld heart sound recorder in patients with heart failure - SELPH multicenter pilot study. J Cardiol 2024:S0914-5087(24)00082-0. [PMID: 38701945 DOI: 10.1016/j.jjcc.2024.04.009] [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: 12/03/2023] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Multi-parametric assessment, including heart sounds in addition to conventional parameters, may enhance the efficacy of noninvasive telemonitoring for heart failure (HF). We sought to assess the feasibility of self-telemonitoring with multiple devices including a handheld heart sound recorder and its association with clinical events in patients with HF. METHODS Ambulatory HF patients recorded their own heart sounds, mono‑lead electrocardiograms, oxygen saturation, body weight, and vital signs using multiple devices every morning for six months. RESULTS In the 77 patients enrolled (63 ± 13 years old, 84 % male), daily measurements were feasible with a self-measurement rate of >70 % of days in 75 % of patients. Younger age and higher Minnesota Living with Heart Failure Questionnaire scores were independently associated with lower adherence (p = 0.002 and 0.027, respectively). A usability questionnaire showed that 87 % of patients felt self-telemonitoring was helpful, and 96 % could use the devices without routine cohabitant support. Six patients experienced ten HF events of re-hospitalization and/or unplanned hospital visits due to HF. In patients who experienced HF events, a significant increase in heart rate and diastolic blood pressure and a decrease in the time interval from Q wave onset to the second heart sound were observed 7 days before the events compared with those without HF events. CONCLUSIONS Self-telemonitoring with multiple devices including a handheld heart sound recorder was feasible even in elderly patients with HF. This intervention may confer a sense of relief to patients and enable monitoring of physiological parameters that could be valuable in detecting the deterioration of HF.
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Affiliation(s)
- Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.
| | | | | | - Yuki Tanaka
- Solution Business Development, Philips Japan, Ltd., Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenji Inoue
- Department of Cardiovascular Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Akihiro Sato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Daida
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
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3
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Masotta V, Dante A, Caponnetto V, Marcotullio A, Ferraiuolo F, Bertocchi L, Camero F, Lancia L, Petrucci C. Telehealth care and remote monitoring strategies in heart failure patients: A systematic review and meta-analysis. Heart Lung 2024; 64:149-167. [PMID: 38241978 DOI: 10.1016/j.hrtlng.2024.01.003] [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: 09/20/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Heart failure (HF) is a cardiac clinical syndrome that involves complex pathological aetiologies. It represents a growing public health issue and affects a significant number of people worldwide. OBJECTIVES To synthesize evidence related to the impact of telemonitoring strategies on mortality and hospital readmissions of heart failure patients. METHODS A systematic literature review was conducted using PubMed, Scopus, CINAHL, IEEE Xplore Digital Library, Engineering Source, and INSPEC. To be included, studies had to be in English or Italian and involve heart failure patients of any NYHA class, receiving care through any telecare, remote monitoring, telemonitoring, or telehealth programmes. Articles had to contain data on both mortality and number of patients who underwent rehospitalizations during follow-ups. To explore the effectiveness of telemonitoring strategies in reducing both one-year all-cause mortality and one-year rehospitalizations, studies were synthesized through meta-analyses, while those excluded from meta-analyses were summarized narratively. RESULTS Sixty-one studies were included in the review. Narrative synthesis of data suggests a trend towards a reduction in deaths among monitored patients, but the number of rehospitalized patients was higher in this group. Meta-analysis of studies reporting one-year all-cause mortality outlined the protective power of care models based on telemonitoring in reducing one-year all-cause mortality. Meta-analysis of studies reporting the number of rehospitalized patients in one-year outlined that telemonitoring is effective in reducing the number of rehospitalized patients when compared with usual care strategies. CONCLUSION Evidence from this review confirms the benefits of telemonitoring in reducing mortality and rehospitalizations of HF patients. Further research is needed to reduce the heterogeneity of the studies.
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Affiliation(s)
- Vittorio Masotta
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Angelo Dante
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy.
| | - Valeria Caponnetto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Alessia Marcotullio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Fabio Ferraiuolo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Luca Bertocchi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Francesco Camero
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Loreto Lancia
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
| | - Cristina Petrucci
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Giuseppe Petrini, L'Aquila 67100, Italy
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Bianco F, Bucciarelli V, Santolla F. Heart failure home monitoring: Are we monitoring the patient or the disease? Trends Cardiovasc Med 2024:S1050-1738(24)00016-1. [PMID: 38387746 DOI: 10.1016/j.tcm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Francesco Bianco
- Department of Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy.
| | - Valentina Bucciarelli
- Department of Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Francesca Santolla
- Libera Università Mediterranea (LUM) "Giuseppe Degennaro", Casamassima, Bari, Italy
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5
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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6
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Scholte NTB, Gürgöze MT, Aydin D, Theuns DAMJ, Manintveld OC, Ronner E, Boersma E, de Boer RA, van der Boon RMA, Brugts JJ. Telemonitoring for heart failure: a meta-analysis. Eur Heart J 2023; 44:2911-2926. [PMID: 37216272 PMCID: PMC10424885 DOI: 10.1093/eurheartj/ehad280] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided. METHODS AND RESULTS A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996-July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77-0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74-0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76-0.96, I2: 70%). CONCLUSION These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS.
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Affiliation(s)
- Niels T B Scholte
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Muhammed T Gürgöze
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dilan Aydin
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Eelko Ronner
- Department of Cardiology, Reinier de Graaf Hospital, Reinier de Graafweg 5, Delft, South Holland 2625 AD, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
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7
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Pegoraro V, Bidoli C, Dal Mas F, Bert F, Cobianchi L, Zantedeschi M, Campostrini S, Migliore F, Boriani G. Cardiology in a Digital Age: Opportunities and Challenges for e-Health: A Literature Review. J Clin Med 2023; 12:4278. [PMID: 37445312 DOI: 10.3390/jcm12134278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
To date, mortality rates associated with heart diseases are dangerously increasing, making them the leading cause of death globally. From this point of view, digital technologies can provide health systems with the necessary support to increase prevention and monitoring, and improve care delivery. The present study proposes a review of the literature to understand the state of the art and the outcomes of international experiences. A reference framework is defined to develop reflections to optimize the use of resources and technologies, favoring the development of new organizational models and intervention strategies. Findings highlight the potential significance of e-health and telemedicine in supporting novel solutions and organizational models for cardiac illnesses as a response to the requirements and restrictions of patients and health systems. While privacy concerns and technology-acceptance-related issues arise, new avenues for research and clinical practice emerge, with the need to study ad hoc managerial models according to the type of patient and disease.
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Affiliation(s)
- Veronica Pegoraro
- Governance and Social Innovation (GSI) Centre, Ca' Foscari Foundation, 30123 Venice, Italy
- Department of Economics, Ca' Foscari University, 30123 Venice, Italy
| | - Chiara Bidoli
- Governance and Social Innovation (GSI) Centre, Ca' Foscari Foundation, 30123 Venice, Italy
- Department of Economics, Ca' Foscari University, 30123 Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University, 30123 Venice, Italy
| | - Fabrizio Bert
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy
- Infection Prevention and Control Unit, ASL TO3 Hospitals, 10098 Turin, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- ITIR-Institute for Transformative Innovation Research, University of Pavia, 27100 Pavia, Italy
| | - Maristella Zantedeschi
- Governance and Social Innovation (GSI) Centre, Ca' Foscari Foundation, 30123 Venice, Italy
- Department of Economics, Ca' Foscari University, 30123 Venice, Italy
| | - Stefano Campostrini
- Governance and Social Innovation (GSI) Centre, Ca' Foscari Foundation, 30123 Venice, Italy
- Department of Economics, Ca' Foscari University, 30123 Venice, Italy
- ITIR-Institute for Transformative Innovation Research, University of Pavia, 27100 Pavia, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
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8
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Javaid SS, Khan MU, Paryani NS, Ansari SA, Mohiuddin N, Merza N, Ehsan N, Waheed ST, Saleem MS, Tahir HB, Moiz MA, Siddiqi TJ. Remote Monitoring in Heart Failure patients: A Systemic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101635. [PMID: 36773950 DOI: 10.1016/j.cpcardiol.2023.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Heart failure (HF) approximately affects about 1%-2% of the adult population in developed countries and is a leading cause of morbidity and mortality worldwide. Inadequate HF management occurs because of poor adherence to prescribed medications. This meta-analysis compares and contrasts standard care with remote medication monitoring in HF patients. Six randomized control trials were selected using the PubMed database from inception until October 25, 2022, incorporating a total of 2390 patients with HF, out of which 1260 were subjected to remote monitoring while the remaining were in the control group. An odds ratio (OR) with a confidence interval (CI) of 95% was calculated. Remote monitoring in HF patients did not significantly reduce the risks of Cardiovascular (CV) hospitalization <6 months (RR = 0.32, P = 0.27), emergency department (ED) visits (RR = 0.95, P = 0.56) and all-cause mortality (RR = 1.08, P = 0.36). However, a significant reduction in CV hospitalization >6 months was associated with remote monitoring (RR = 0.83, P = 0.002). The meta-analysis revealed that remote monitoring does not significantly reduce the risks of CV hospitalizations, ED visits, or mortality in patients with HF. Therefore, standard care methods must continue to be utilized in HF management.
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Affiliation(s)
- Syed S Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Saad A Ansari
- University of California, Riverside School of Medicine, Riverside, CA
| | | | - Nooraldin Merza
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Naija Ehsan
- Jinnah Medical and Dental College, Karachi, Pakistan
| | - Syeda T Waheed
- Liaquat National Medical College and Hospital, Karachi, Pakistan
| | | | - Haris B Tahir
- Ameer ud Din Medical College, Post Graduate Medical Institute, Lahore, Pakistan
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9
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Ghani U, Farooq O, Aziz S, Alam S, Khan MJ, Rahim O. The Spectrum of Heart Failure Management. Cureus 2023; 15:e40587. [PMID: 37469814 PMCID: PMC10353487 DOI: 10.7759/cureus.40587] [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: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
Heart failure, a complex cardiovascular condition, is a huge burden on patients, caregivers, and healthcare systems and it is prevalent worldwide. Heart failure is caused by a wide variety of underlying conditions that include both cardiac and non-cardiac pathologies. Identifying the underlying cause enables us to apply etiology-based interventions. The spectrum of heart failure management ranges from classification to transplantation. In addition to its classification and monitoring, this article reviews various management strategies, including both conventional methods and the latest innovations. These include lifestyle interventions, pharmacotherapy, device therapy, transplantation, and regenerative medicine.
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Affiliation(s)
- Usman Ghani
- Cardiology, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Omer Farooq
- Internal Medicine, Ascension Saint Francis Hospital, Evanston, USA
| | - Sundal Aziz
- Cardiology, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Sundus Alam
- Acute Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GBR
| | - Muhammad Junaid Khan
- Orthopaedic Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GBR
| | - Omar Rahim
- Cardiology, Naseer Teaching Hospital, Peshawar, PAK
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Alvarado E, Grágeda N, Luzanto A, Mahu R, Wuth J, Mendoza L, Yoma NB. Dyspnea Severity Assessment Based on Vocalization Behavior with Deep Learning on the Telephone. SENSORS (BASEL, SWITZERLAND) 2023; 23:2441. [PMID: 36904646 PMCID: PMC10007248 DOI: 10.3390/s23052441] [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: 12/13/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
In this paper, a system to assess dyspnea with the mMRC scale, on the phone, via deep learning, is proposed. The method is based on modeling the spontaneous behavior of subjects while pronouncing controlled phonetization. These vocalizations were designed, or chosen, to deal with the stationary noise suppression of cellular handsets, to provoke different rates of exhaled air, and to stimulate different levels of fluency. Time-independent and time-dependent engineered features were proposed and selected, and a k-fold scheme with double validation was adopted to select the models with the greatest potential for generalization. Moreover, score fusion methods were also investigated to optimize the complementarity of the controlled phonetizations and features that were engineered and selected. The results reported here were obtained from 104 participants, where 34 corresponded to healthy individuals and 70 were patients with respiratory conditions. The subjects' vocalizations were recorded with a telephone call (i.e., with an IVR server). The system provided an accuracy of 59% (i.e., estimating the correct mMRC), a root mean square error equal to 0.98, false positive rate of 6%, false negative rate of 11%, and an area under the ROC curve equal to 0.97. Finally, a prototype was developed and implemented, with an ASR-based automatic segmentation scheme, to estimate dyspnea on line.
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Affiliation(s)
- Eduardo Alvarado
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Nicolás Grágeda
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Alejandro Luzanto
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Rodrigo Mahu
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Jorge Wuth
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Laura Mendoza
- Clinical Hospital, University of Chile, Santiago 8380420, Chile
| | - Néstor Becerra Yoma
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
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Kushniruk A, Martin-Juchat F. Patients' Information Needs Related to a Monitoring Implant for Heart Failure: Co-designed Study Based on Affect Stories. JMIR Hum Factors 2023; 10:e38096. [PMID: 36689266 PMCID: PMC9947817 DOI: 10.2196/38096] [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: 03/18/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND RealWorld4Clinic is a European consortium that is currently developing an implantable monitoring device for acute heart failure prevention. OBJECTIVE This study aimed to identify the main issues and information needs related to this new cardiac implant from the patients' perspective. METHODS A total of 3 patient collaborators were recruited to help us design the study. During 4 remotely held meetings (each lasting for 2 hours), we defined the main questions and hypotheses together. Next, 26 additional interviews were conducted remotely to test these hypotheses. During both phases, we used affect stories, which are life narratives focusing on affect and the relationship between patients and the care ecosystem, to highlight the main social issues that should be addressed by the research according to the patients. RESULTS Context of diagnosis, age, and severity of illness strongly influence patient experience. However, these variables do not seem to influence the choice regarding being implanted, which relies mostly on the individual patient's trust in their physicians. It seems that the major cause of anxiety for the patient is not the implant but the disease itself, although some people may initially be concerned over the idea of becoming a cyborg. Remote monitoring of cardiac implants should draw on existing remote disease management programs focusing on a long-term relationship between the patient and their medical team. CONCLUSIONS Co-design with affect stories is a useful method for quickly identifying the main social issues related to information about a new health technology.
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Affiliation(s)
| | - Fabienne Martin-Juchat
- GRESEC - Groupe de Recherche Sur les Enjeux de la Communication, Université Grenoble Alpes, Échirolles, France
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Relationship between Cardiac Acoustic Biomarkers and Pulmonary Artery Pressure in Patients with Heart Failure. J Clin Med 2022; 11:jcm11216373. [DOI: 10.3390/jcm11216373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure (HF), early and non-invasive detection of this sign is useful in HF care. This study aimed to assess whether cardiac acoustic biomarkers (CABs) are associated with the elevation of PAP in patients with HF. Patients with HF scheduled to undergo right heart catheterization were prospectively enrolled. CABs were concurrently recorded during catheterization at rest (baseline) and while applying a handgrip (exercise). Forty-nine patients were included in the analysis, and their mean PAP significantly increased after exercise compared to baseline. Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p = 0.014 and r = 0.363; p = 0.010) and S3 Strength (r = 0.375; p = 0.009 and r = 0.386; p = 0.007) were consistent throughout baseline and exercise. The response of CABs to exercise-induced PAP elevation was divided into two patterns: increasing and decreasing. The frequency of cardiac index below 2.2 mL/m2 was significantly higher in the decreasing pattern. CABs related to S2 and S3 showed significant correlations with absolute PAP values both at baseline and after exercise in patients with HF, but no significant correlations between their changes from baseline to post-exercise were observed in this study population. Further research is therefore needed to assess whether CABs can sensitively reflect changes in PAP according to HF status and underlying phenotypes.
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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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Informal Caregivers’ Experiences with Performing Telemonitoring in Heart Failure Care at Home—A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10071237. [PMID: 35885765 PMCID: PMC9324585 DOI: 10.3390/healthcare10071237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.
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Avila MS, Belfort DDSP. Há uma Função para o Telemonitoramento na Insuficiência Cardíaca? Arq Bras Cardiol 2022; 118:605-606. [PMID: 35319610 PMCID: PMC8959035 DOI: 10.36660/abc.20220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Arpaia P, Crauso F, De Benedetto E, Duraccio L, Improta G, Serino F. Soft Transducer for Patient's Vitals Telemonitoring with Deep Learning-Based Personalized Anomaly Detection. SENSORS 2022; 22:s22020536. [PMID: 35062496 PMCID: PMC8777728 DOI: 10.3390/s22020536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
Abstract
This work addresses the design, development and implementation of a 4.0-based wearable soft transducer for patient-centered vitals telemonitoring. In particular, first, the soft transducer measures hypertension-related vitals (heart rate, oxygen saturation and systolic/diastolic pressure) and sends the data to a remote database (which can be easily consulted both by the patient and the physician). In addition to this, a dedicated deep learning algorithm, based on a Long-Short-Term-Memory Autoencoder, was designed, implemented and tested for providing an alert when the patient’s vitals exceed certain thresholds, which are automatically personalized for the specific patient. Furthermore, a mobile application (EcO2u) was developed to manage the entire data flow and facilitate the data fruition; this application also implements an innovative face-detection algorithm that ensures the identity of the patient. The robustness of the proposed soft transducer was validated experimentally on five individuals, who used the system for 30 days. The experimental results demonstrated an accuracy in anomaly detection greater than 93%, with a true positive rate of more than 94%.
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Affiliation(s)
- Pasquale Arpaia
- Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), University of Naples Federico II, 80125 Naples, Italy;
- Department of Information Technology and Electrical Engineering (DIETI), University of Naples Federico II, 80125 Naples, Italy
| | - Federica Crauso
- Department of Public Health, University of Naples Federico II, 80125 Naples, Italy; (F.C.); (G.I.)
| | - Egidio De Benedetto
- Department of Information Technology and Electrical Engineering (DIETI), University of Naples Federico II, 80125 Naples, Italy
- Correspondence:
| | - Luigi Duraccio
- Department of Electronics and Telecommunications, Polytechnic University of Turin, 10129 Turin, Italy;
| | - Giovanni Improta
- Department of Public Health, University of Naples Federico II, 80125 Naples, Italy; (F.C.); (G.I.)
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Radhoe SP, Brugts JJ. CardioMEMS™: a tool for remote hemodynamic monitoring of chronic heart failure patients. Future Cardiol 2021; 18:173-183. [PMID: 34697954 DOI: 10.2217/fca-2021-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Remote monitoring is becoming increasingly important for management of chronic heart failure patients. Recently, hemodynamic monitoring by measuring intracardiac filling pressures has been gaining attention. It is believed that hemodynamic congestion precedes clinical congestion by several weeks and that remote hemodynamic monitoring therefore enables clinicians to intervene in an early stage and prevent heart failure hospitalizations. The CardioMEMS HF system (Abbott, CA, USA) is a sensor capable of measuring pulmonary artery pressures as a surrogate of left ventricular filling pressures. Clinical evidence for CardioMEMS has been convincing in terms of efficacy and safety. This article provides detailed information on the CardioMEMS HF system and summarizes all available evidence of this promising technique.
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Affiliation(s)
- Sumant P Radhoe
- Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
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