Impact of remote monitoring in heart failure patients with cardiac implantable electronic devices during COVID-19 pandemic: a single center experience

Abstract

Background Coronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions. Methods Patients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups. Results No significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672). In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients. Conclusions Specified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.

Negative effects of COVID‐19 on the implantation rate of cardiac resynchronization therapy with defibrillator device

“…4 Alerts from the remote heart failure monitoring system allowed for prompt interventions to prevent further progression and reduce hospitalizations when compared with the traditional in-office CRT-D evaluation. 25 The European Heart Rhythm Association survey before and during the pandemic showed a significant increase in the use of remote monitoring for pacemakers, loop recorders, cardiovascular electronic implantable devices (CEIDs), and CRT-p, as well as a decrease in in-office visits during the pandemic. 5 ICD and CRT-D remote readmissions when compared to medical therapy.…”

“…Providers were able to better predict heart failure exacerbations, detect arrhythmias, identify malfunctions, decrease healthcare visits and costs, and reduce exposure to COVID‐19 4 . Alerts from the remote heart failure monitoring system allowed for prompt interventions to prevent further progression and reduce hospitalizations when compared with the traditional in‐office CRT‐D evaluation 25 . The European Heart Rhythm Association survey before and during the pandemic showed a significant increase in the use of remote monitoring for pacemakers, loop recorders, cardiovascular electronic implantable devices (CEIDs), and CRT‐ p , as well as a decrease in in‐office visits during the pandemic 5 .…”

Editorial: Developments in cardiac implantable electronic device therapy: how can we improve clinical implementation?

“…Remote monitoring of CIED patients has not only evolved as a technology to unburden daily clinical routine from growing patient contacts but has also shown to lower HF worsening rates during the COVID-19 pandemic ( 6 ). Xiong et al expand the idea of remote monitoring to remotely control and reprogram a device in real-time using a 5G-cloud technology system.…”