Heart rate score and outcomes in ICD patients: insights from the prospective randomized INTRINSIC RV trial

Gopinathannair, Rakesh; Sharma, Arjun; Jones, Paul; English, Connor; Furmanek, Stephen; Olshansky, Brian

doi:10.1007/s10840-021-01091-y

Cited by 6 publications

(16 citation statements)

References 6 publications

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“…Additional HF sensors, such as pulmonary artery pressure sensors, have been proposed to risk‐stratify and prevent HF readmissions 19 . Sensors in implantable devices such as heart rate, 20 thoracic impedance, 21 and activity 22 have been shown to have predictive value for HF readmission. The addition of unique sensors may improve the predictive value, particularly when combined with a risk index which has been shown to have strong risk prediction abilities 6 .…”

Section: Discussionmentioning

confidence: 99%

PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

Boehmer,

Sauer,

Gardner

et al. 2023

ESC Heart Failure

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AimsThe HeartLogic multisensor index has been found to be a sensitive predictor of worsening heart failure (HF). However, there is limited data on this index's association and its constituent sensors with HF readmissions.Methods and resultsThe PREEMPT‐HF study is a global, multicentre, prospective, observational, single‐arm, post‐market study. HF patients with an implantable defibrillator device or cardiac resynchronization therapy with defibrillator with HeartLogic capabilities were eligible if sensor data collection was turned on and the HeartLogic feature was not enabled. Thus, the HeartLogic Index/alert and heart sounds sensor trends were unavailable via the LATITUDE remote monitoring system to clinicians (blinded). Evaluation of subject medical records at 6 months and a final in‐clinic visit at 12 months was required for collection of all‐cause hospitalizations and HF outpatient visits. The purpose of this study is exploratory, no formal hypothesis tests are planned, and no adjustment for multiple testing will be performed. A total of 2183 patients were enrolled at 103 sites between June 2018 and June 2020. A significant proportion of the patients were implanted with implantable defibrillator devices (39%) versus cardiac resynchronization therapy with defibrillator (61%); were female (27%); over 65 (61%); New York Heart Association class I (13%), II (53%), and III (33%); ejection fraction < 25% (21%); ischaemic (50%); and with a history of renal dysfunction (23%).ConclusionsThe PREEMPT study will provide clinical data and blinded sensor trends for the characterization of sensor changes with HF readmission, tachyarrhythmias, and event subgroups. These data may help to refine the clinical use of HeartLogic and to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

Boehmer,

Sauer,

Gardner

et al. 2023

ESC Heart Failure

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“…1 In another trial HRS was an independent predictor of mortality or heart failure (HF) hospitalization in a population of patients with dual-chamber ICD. 3 Although promising these trials were not specific for HF patients. Remote monitoring (RM) is an increasingly used tool in HF management and HRS is a simple and easy to obtain index that may help predict clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Heart rate score in remote monitoring: An additional tool for predicting outcomes in heart failure with reduced ejection fraction

Barradas,

Coutinho dos Santos,

Duarte

et al. 2024

Pacing Clinical Electrophis

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BackgroundHeart rate score (HRS) ≥ 70% has been associated with arrhythmic events and mortality but these studies were not specific for heart failure (HF) patients. We hypothesized that HRS ≥ 70% obtained from remote monitoring (RM) is associated with HF hospitalizations and arrhythmic events in HF with reduced ejection fraction (HFrEF).MethodsHRS was calculated from RM in patients with HFrEF and ICD or CRT‐D. Two groups were defined: HRS ≥ 70% (G1, n = 55) and HRS < 70% (G2, n = 48)ResultsA total of 103 patients were included (64.4 ± 13.04 years, 69.9% male, mean left ventricular ejection fraction (LVEF) 33.62 ± 11.97% and FUP 61.7 ± 38.87 months). The device was CRT‐D in 59.2% and ICD in 40.8% and the majority (90.3%) had the device implanted in primary prevention. G1 patients were more frequently male (p = .017) and had more coronary disease (p = .035). HRS ≥70% was an independent predictor for unplanned HF hospitalizations (OR: 1.905 (95% CI: 1.328–3.649), p < .001)). The indication for device implantation (primary vs. secondary prevention), type of device, NYHA class, age, gender and LVEF were not independent predictors of the outcome. VF (4.9 ± 20.0 G1 vs. 1.1 ± 5.47 G2, p = .046) and VT episodes were more prevalent in G1 (3.1 ± 8.93 G1 vs. 0.3 ± 1.59 G2, p = .026), as well as appropriate device shocks (4.3 ± 12.06 G1 vs. 0.3 ± 1.49 G2, p = .023). There was no difference in inappropriate shocks or mortality outcomes between groups.ConclusionHRS ≥70% obtained from RM was an independent predictor of HF hospitalizations and was associated with arrhythmic events with VT and VF episodes and appropriate device shocks in HFrEF patients.

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“…The copyright holder for this preprint this version posted February 10, 2023 assessment of HRSc. 1,2 Remotely monitored databases of PM patients offer the opportunity to assess associations between interrogated data from cardiac devices and clinical outcomes as recorded in device data.…”

Section: Introductionmentioning

confidence: 99%

“…Heart rate score (HRSc), a novel parameter, is defined by the percentage of all paced and sensed atrial beats in the tallest 10-beat/minute heart rate histogram bin, recorded by a cardiac implantable pacemaker (PM) or implantable cardioverter-defibrillator (DDD-ICD) with an atrial lead, (Figure 1). A HRSc ≥70%, early post-implantation, correlates with mortality in patients without atrial fibrillation (AF) who have ICDs 1 or cardiac resynchronization therapy defibrillators (CRT-Ds). 2,3 Atrial High-Rate Episodes (AHREs), detected by cardiac devices, is associated with increased risk of stroke, systemic embolism, heart failure, and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…In previous studies of HRSc, subjects with atrial tachyarrhythmias >24 hours detected by cardiac devices were excluded since frequent or persistent AF distorts the Heart Rate Score and Atrial Fibrillation 2/6/ 23 Hayashi K 4 assessment of HRSc. 1,2 Remotely monitored databases of PM patients offer the opportunity to assess associations between interrogated data from cardiac devices and clinical outcomes as recorded in device data.…”

Section: Introductionmentioning

confidence: 99%

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Initial Heart Rate Score Predicts New Onset Atrial Fibrillation in Pacemaker Patients

Hayashi

Abe

Olshansky

et al. 2023

Preprint

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Background: Heart Rate Score (HRSc), the percent of all atrial paced and sensed event in the largest 10 bpm rate histogram bin of a pacemaker, predicts survival in patients with cardiac devices. No correlation between HRSc and development of atrial fibrillation (AF) has been reported. Objective: To evaluate the relationship between pacemaker post-implantation HRSc and newly-developed AF incidence. Methods: Patients with dual-chamber pacemakers, implanted 2013-2017, with ALTITIUDE remote monitoring data with {greater than or equal to}600,000 beats of histogram data collected at baseline were included (N=34,543). HRSc was determined from the post-implantation histogram data during the initial 3 months. Patients were excluded if they had AF, defined as atrial high-rate episodes >5 minutes or >1% of right atrial beats >170 bpm during the initial 3-months post-implantation. New AF, after the baseline period, was defined by each of the following: >1%, >10% or >25% of atrial beats >170 bpm or Atrial Tachycardia Response (ATR) events >24 hr. Results: Patients were followed a median of 2.8 (1.0-4.0) years. Patients with initial HRSc{greater than or equal to}70% were older, had higher %RA pacing, had lower %RV pacing and were more likely programmed with rate-response vs subjects with HRSc<70%. The incidence of AF increased in proportion to HRSc (Log-Rank P-value <0.001); results were insensitive to AF definition. Initial HRSc (HR:1.07, 95% CI:1.05-1.09; P<0.0001) independently predicted AF after adjusting for age, gender, % RV pacing and rate-response programming. The %RA pacing and initial HRSc correlated. Conclusion: HRSc predicts subsequent AF independent of well-known risk factors in pacemaker patients.

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Heart rate score and outcomes in ICD patients: insights from the prospective randomized INTRINSIC RV trial

Cited by 6 publications

References 6 publications

PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

Heart rate score in remote monitoring: An additional tool for predicting outcomes in heart failure with reduced ejection fraction

Initial Heart Rate Score Predicts New Onset Atrial Fibrillation in Pacemaker Patients

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