Prognostic Impact of Long-term Remote Monitoring in Heart Failure
Patients with Implantable Devices
Preliminary Analysis
Joana Feliciano, Mário Oliveira, Rui Soares, Nogueira da Silva, Pedro S. Cunha, Tiago P. Silva,
Luísa Branco, Sandra Alves, Ricardo Pimenta and Rui Cruz Ferreira
Cardiology Department, Hospital de Santa Marta, Lisboa, Portugal
BACKGROUND
Repeated hospitalizations in patients with
chronic heart failure with low left ventricular
ejection fraction (CHF) are a leading cause of
hospital readmission (McMurray, Eur Heart J,
2012), with impact on mortality (Stewart S, Eur
J Heart Fail, 2001). 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 (Whellan, JACC 2010),
allowing tailored intervention and therefore
avoiding hospital admission (Yu, Circulation
2005). 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 (Bui, JACC 2012).
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.
CONCLUSIONS
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. Further testing will be needed to increase
specificity and sensivity of a remote follow-up
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..
Prognostic Impact of Long-term Remote Monitoring in Heart Failure Patients with Implantable Devices - Preliminary Analysis.
Copyright
c
 2013 SCITEPRESS (Science and Technology Publications, Lda.)

strategy to detect and prevent HF
decompensations.
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