Background-The predictive value of heart rate variability (HRV) in chronic heart failure (CHF) has never been tested in a comprehensive multivariate model using short-term laboratory recordings designed to avoid the confounding effects of respiration and behavioral factors. Methods and Results-A multivariate survival model for the identification of sudden (presumably arrhythmic) death was developed with data from 202 consecutive patients referred between 1991 and 1995 with moderate to severe CHF (age 52Ϯ9 years, left ventricular ejection fraction 24Ϯ7%, New York Heart Association class 2.3Ϯ0.7; the derivation sample). Time-and frequency-domain HRV parameters obtained from an 8Ј recording of ECG at baseline and during controlled breathing (12 to 15 breaths/min) were challenged against clinical and functional parameters. This model was then validated in 242 consecutive patients referred between 1996 and 2001 (validation sample). In the derivation sample, sudden death was independently predicted by a model that included low-frequency power (LFP) of HRV during controlled breathing Յ13 ms 2 and left ventricular end-diastolic diameter Ն77 mm (relative risk [RR] 3.7, 95% CI 1.5 to 9.3, and RR 2.6, 95% CI 1.0 to 6.3, respectively). The derivation model was also a significant predictor in the validation sample (Pϭ0.04). In the validation sample, LFP Յ11 ms 2 during controlled breathing and Ն83 ventricular premature contractions per hour on Holter monitoring were both independent predictors of sudden death (RR 3.0, 95% CI 1.2 to 7.6, and RR 3.7, 95% CI 1.5 to 9.0, respectively). Conclusions-Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients withCHF that is independent of many other variables. These results refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator. (Circulation. 2003;107:565-570.)

AimsThe Home or Hospital in Heart failure (HHH) study was a European Community-funded, multinational, randomized controlled clinical trial, conducted in the UK, Poland, and Italy, to assess the feasibility of a new system of home telemonitoring (HT). The HT system was used to monitor clinical and physiological parameters, and its effectiveness (compared with usual care) in reducing cardiac events in heart failure (HF) patients was evaluated. Measurements were patient-managed. Methods and resultsFrom 2002 to 2004, 461 HF patients (age 60 + 11 years, New York Heart Association class 2.4 + 0.6, left ventricular ejection fraction 29 + 7%) were enrolled at 11 centres and randomized (1:2) to either usual outpatient care or HT administered as three randomized strategies: (i) monthly telephone contact; (ii) strategy 1 plus weekly transmission of vital signs; and (iii) strategy 2 plus monthly 24 h recording of cardiorespiratory activity. Patients completed 81% of vital signs transmissions, as well as 92% of cardiorespiratory recordings. Over a 12-month follow-up, there was no significant effect of HT in reducing bed-days occupancy for HF or cardiac death plus HF hospitalization. Post hoc analysis revealed a heterogeneous effect of HT in the three countries with a trend towards a reduction of events in Italy. ConclusionHome or Hospital in Heart failure indicates that self-managed HT of clinical and physiological parameters is feasible in HF patients, with surprisingly high compliance. Whether HT contributes to a reduction of cardiac events requires further investigation.--

In moderate-to-severe chronic heart failure patients, the 6-min walk test is not related to cardiac function and only moderately related to exercise capacity. Walking performance does not provide prognostic information which can complement or substitute for that provided by peak VO2 or NYHA class. Hence the test is of limited usefulness as a decisional indicator in clinical practice.

Background Telemonitoring care can be integrated into health care provision as a substitute for routine clinical follow-up. A telemonitoring service (TMS) integrated into the process of chronic heart failure (CHF) care has not so far been evaluated. Objectives We describe our comprehensive home TMS and evaluate its outcomes in comparison to the usual program of care after discharge from a Heart Failure Unit (HFU). Methods 133 patients discharged from a HFU, underwent risk cluster classification for cardiac events and were prospectively randomized to usual community care (n = 66) and to a management program delivered by the TMS (n = 67). Clinical outcome including re-hospitalization, cardiac death, and emergency room access, was compared in the two groups. Results Patients were clustered as at low (n = 51), moderate (n = 43) and high (n = 39) risk. The compliance to telemonitoring was 82%. The compliance to system follow-up was (81%). The mean individual access rate to the TMS was 4.6 ± 3.3 calls. Active interventions were made following 54% of the accesses. After 10 ± 6 months, 135 events had occurred: 103 in the usual care group and 32 in telemonitoring group (P < 0.001). Re-hospitalisation was 22 (TMS) vs 77 (usual care) (P < 0.009). Cluster risk classification intercepted patients' increased health care demands (low risk: 0.34 ± 0.62; moderate risk 1 ± 1.2; high risk 1.9 ± 1.5 events). Conclusion A management program delivered by a TMS can reduce health care demands by CHF patients.