Prognostic Impact of Long-term Remote Monitoring in Heart Failure Patients with Implantable Devices - Preliminary Analysis

Joana Feliciano, Mário Oliveira, Rui Soares, Manuel Nogueira da Silva, Pedro Silva Cunha, Tiago Pereira da Silva, Luísa Branco, Sandra Alves, Ricardo Pimenta, Rui Cruz Ferreira

Abstract

Background. Repeated hospitalizations in patients with chronic heart failure with low left ventricular ejection fraction (CHF) are a leading cause of hospital readmission, with impact on mortality. It represents a growing public health problem, namely as a determinant of health care expenditure. Remote monitoring in CHF patients with implantable devices has been a target of interest, as it may facilitate the identification of patients facing higher risk of acute decompensation, allowing tailored intervention and therefore avoiding hospital admission. It will ultimately affect CHF outcomes, economic burden of heart failure and quality of life, and is an area of great clinical interest and under active investigation. Purpose. To evaluate the first incoming results of the remote monitoring in CHF patients submitted to cardiac resynchronization therapy (CRT) devices implantation. Methods. Seventy-one patients with CRT devices (76% male, age 67±10 years, ejection fraction of 25±6% previous to CRT, 60% with non-ischemic cardiomyopathy, 28% with atrial fibrilation, 90% having a CRT combined with cardioverter-defibrillator) and more than 1-year follow-up. There were 74% of clinical responders (stable functional improvement ≥1 NYHA class). From the potential measurements for CHF monitoring, we considered automatic alarm checks of intrathoracic impedance and atrial or ventricular tachyarrhythmias detection, and retrospectively analysed acute decompensated heart failure episodes with hospital admission and overall mortality. Results. After a mean follow-up of 2.5±0.97 years, there were eight (11.2%) hospital admissions and one fatal outcome due to heart failure. In 75% of the hospitalised patients, device alert occurred previously, with elevated threshold of intrathoracic impedance (p<0.01; Fisher) and arrhythmia detection (both atrial and ventricular) (p<0.0001; Fisher). These alarms were automatically activated on the remote monitoring system on a medium period of 36 days previous to the hospital admission and two days prior (ventricular arrhythmia detection) on the fatal case. In this population, echocardiographic parameters pre- or post-CRT implant and clinical response to the CRT were not independent predictors of hospital admissions. Conclusion. Remote monitoring systems represent an advantage in the complex follow-up of CHF patients with CRT devices, and can play a fundamental role in future strategies of therapeutic optimization to reduce hospital admissions due to acute decompensated heart failure.

References

  1. Yu C. M., Wang L., Chau E., Chan R. H., Kong S. L., Tang M. O., Christensen J., Stadler R. W., Lau C. P. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005 Aug 9;112(6):841- 8.
  2. Bui A. L., Fonarow G. C. Home monitoring for heart failure management. J Am Coll Cardiol. 2012 Jan 10;59(2):97-104.
Download


Paper Citation


in Harvard Style

Feliciano J., Oliveira M., Soares R., Nogueira da Silva M., Silva Cunha P., Pereira da Silva T., Branco L., Alves S., Pimenta R. and Ferreira R. (2013). Prognostic Impact of Long-term Remote Monitoring in Heart Failure Patients with Implantable Devices - Preliminary Analysis . In - CRM, (CARDIOTECHNIX 2013) ISBN , pages 0-0


in Bibtex Style

@conference{crm13,
author={Joana Feliciano and Mário Oliveira and Rui Soares and Manuel Nogueira da Silva and Pedro Silva Cunha and Tiago Pereira da Silva and Luísa Branco and Sandra Alves and Ricardo Pimenta and Rui Cruz Ferreira},
title={Prognostic Impact of Long-term Remote Monitoring in Heart Failure Patients with Implantable Devices - Preliminary Analysis},
booktitle={ - CRM, (CARDIOTECHNIX 2013)},
year={2013},
pages={},
publisher={SciTePress},
organization={INSTICC},
doi={},
isbn={},
}


in EndNote Style

TY - CONF
JO - - CRM, (CARDIOTECHNIX 2013)
TI - Prognostic Impact of Long-term Remote Monitoring in Heart Failure Patients with Implantable Devices - Preliminary Analysis
SN -
AU - Feliciano J.
AU - Oliveira M.
AU - Soares R.
AU - Nogueira da Silva M.
AU - Silva Cunha P.
AU - Pereira da Silva T.
AU - Branco L.
AU - Alves S.
AU - Pimenta R.
AU - Ferreira R.
PY - 2013
SP - 0
EP - 0
DO -