Influence of decompensated heart failure on cardiac acoustic biomarkers: impact on early readmissions

Abstract

Aims Preventing hospitalization by detecting early evidence of heart failure (HF) decompensation in an outpatient setting can improve patient's quality of life and reduce costs of care. The purpose of this study was to assess the value of cardiac acoustic biomarkers (CABs), a combination of cardiohaemic vibrations synchronized with ECG signals, and heart rate (HR) for detecting HF decompensation during first 3 months after hospital discharge for HF. Methods and results Patients with an ejection fraction ≤35% (HFrEF) and hospitalized for decompensated HF were enrolled in a prospective observational study. All subjects wore a wearable cardioverter-defibrillator (ZOLL LifeVest ® , Pittsburgh, PA, USA) that is capable of recording CABs and HR. The primary endpoint of the study was the first HF event, defined as HF readmission or HF emergency room visit. From June 2017 through August 2019, 671 patients with HFrEF were enrolled. Eighty-one patients (12.1%) had a total of 112 HF events. The algorithm detected HF events with a median of 32 days (interquartile range = 11-45) in advance of the first HF event. The algorithm had a sensitivity of 69%, specificity of 60%, positive predictive value of 19%, and a negative predictive value of 94%. Of note, the baseline (first 7 days post-enrolment) algorithm using CABs and HR was superior to New York Heart Association classification in detecting patients more likely to have HF decompensation (sensitivity and specificity of 61% and 68% vs. 46% and 55%, respectively). Conclusions This prospective international registry showed that an algorithm incorporating CABs and HR data detected HF events 30 days in advance of the event in patients with HFrEF during first 3 months after hospital discharge. Therefore, integrating CAB technology into clinical practice may prevent HF rehospitalizations.

Virtual healthcare solutions in heart failure: a literature review

“…Nineteen studies reported average EF of the enrolled population ranging from the minimum average EF of 21.5% ( 44 ) to maximum of 58% ( 45 ) with overall mean of 34.1%. Four studies enrolled patients with wearable cardioverter defibrillators which were used for remote data acquisition ( 44 , 46 – 48 ).…”

Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

“…The population provided with a WCD is at risk of acute heart failure as patients are newly diagnosed with a CMP or are in an acute phase of a cardiac disease, and very often, the prescription of a WCD occurs in an inpatient setting. The idea to monitor so-called cardiac acoustic biomarkers (CAB) via sensors on the harness of the WCD came up to identify early evidence of cardiac decompensation in patients with HFrEF and specifically in patients with a left ventricular ejection fraction (LVEF) ≤ 35% in the heart sounds registry, the “HEAR-IT” study [ 51 ] A multiparameter monitoring algorithm was applied on 671 patients (61 ± 13 years) prescribed with a WCD: the cardiohaemic vibrations measured with the defibrillation electrodes adjacent to the patient’s body surface incorporating a three-axis accelerometer and the simultaneously registered two lead surface ECGs. From these sensors, the heart sounds are combined with the information for the ECG, and a combination of the electromechanical activation time (EMAT) and the third heart sound (S3) strength was measured over time; the trend of this combined parameter showed a good correlation to classify patients into groups being at either low or high risk for a heart failure event.…”

“…The initial classification within the first 7 days after discharge from the index hospitalization in high- or low-risk HF events through CABs was more accurate in the prediction of an event compared with the NYHA classification, while on the other hand, the algorithm combining CABs and HR had a negative predictive value of 94% for HF events. The authors proposed the integration of CABs in clinical practice to help prevent HF events [ 51 ] Currently, CABs recorded by the WCD are not available for real-world patient care and were only studied in trials.…”

“…Patients with a lower step count, with a cut-off of 3637 steps per day during the first week after WCD prescription, showed a 4.3 times higher likelihood to receive a shock for VA compared with more active patients, especially in the first month after WCD prescription. Similar to the CABs [ 51 ], a low PA within the first seven days after hospital discharge from the index hospitalization was associated with a higher event rate [ 13 ]. In a study evaluating 4928 female patients, a decline in PA was seen 2 weeks before a WCD treatment for VA [ 57 ] In contrast, all studies about PA in patients after an index HF event attested to the feasibility of telemedical surveilled step count in patients with an overall good compliance as a possible tool for remote monitoring in heart failure [ 13 , 57 , 58 ].…”

Relationship between Cardiac Acoustic Biomarkers and Pulmonary Artery Pressure in Patients with Heart Failure

“…For a long time, physicians have examined the hemodynamic condition of patients with cardiovascular diseases with the aid of auscultation of abnormal heart sounds from the body surface. Currently, the abnormality of heart sounds can be parameterized by computerized algorithms, which are increasingly being used to monitor the condition of patients outside hospitals and to predict deterioration [ 4 , 5 ]. Such parameters are described as cardiac acoustic biomarkers (CABs) [ 6 ] derived from noninvasively measured heart sounds and electrocardiograms obtained from acoustic cardiography [ 7 ].…”