Performance of a multisensor implantable defibrillator algorithm for heart failure monitoring related to co‐morbidities

Abstract

AimsThe HeartLogic algorithm combines multiple implantable defibrillator (ICD) sensor data and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation in cardiac resynchronization therapy (CRT-D) patients. We evaluated the performance of this algorithm in non-CRT ICD patients and in the presence of co-morbidities. Methods and resultsThe HeartLogic feature was activated in 568 ICD patients (410 with CRT-D) from 26 centres. The median follow-up was 26 months [25th-75th percentile: 16-37]. During follow-up, 97 hospitalizations were reported (53 cardiovascular) and 55 patients died. We recorded 1200 HeartLogic alerts in 370 patients. Overall, the time IN the alert state was 13% of the total observation period. The rate of cardiovascular hospitalizations or death was 0.48/patient-year (95% CI: 0.37-0.60) with the HeartLogic IN the alert state and 0.04/patient-year (95%

Harmony in Chaos: Deciphering the Influence of Ischemic Cardiomyopathy and Non-Cardiac Comorbidities on Holter ECG Parameters in Chronic Heart Failure Patients: A Pilot Study

“…In considering future prospects, the utilization of Holter ECG monitoring for individuals with ischemic cardiomyopathy and HF, coupled with emerging comorbidities, has the potential not only to refine risk stratification, but also to guide early therapeutic interventions, contributing to an improvement in the overall quality of life. Presently, there exists no universally accepted risk scoring system specifically tailored for the determination of defibrillator implantation suitability in heart failure patients, and none of the existing scoring systems incorporate HRV as a primary parameter [87,88]. The LVEF assumes paramount significance in the decision-making process regarding eligibility for defibrillator implantation, with LVEF values at or below a commonly accepted threshold of 35%, signifying an indication for primary prevention.…”

“…These algorithmic tools contribute to elucidating the bidirectional causative mechanisms between HF and ventricular arrhythmias, offering potential in discerning predisposing factors. An illustrative case is found in the Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients (MultiSENSE) study, where a novel HF monitoring algorithm, namely the HeartLogic index developed by Boston Scientific, was employed [87,88]. This index amalgamates physiological data derived from multiple sensors integrated into the ICD platform.…”

“…The algorithm amalgamates data from diverse sensors within the implantable device, capturing heart sounds, thoracic impedance, heart rate variability, the respiration rate, and activity levels. By perpetually monitoring these parameters, HeartLogic establishes individualized baseline values and scrutinizes deviations to identify patterns indicative of shifts in the heart failure status [88,91]. Upon detecting noteworthy deviations from baseline values, HeartLogic generates alerts, prompting healthcare providers to assess the patient's condition and adjust treatment strategies accordingly [90,91].…”

“…Lastly, the application of heart failure algorithms within defibrillators, notwithstanding the inclusion of robust parameters, has exhibited variable success in substantiating enhanced survival among patients afflicted with heart failure across diverse clinical trials. This underscores the imperativeness for additional research endeavors aimed at comprehending the intricate determinants that influence the efficacy of these algorithms, with a view to potentially refining their design or implementation strategies [87,88].…”

Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

“…In recent years, the improvement of risk stratification for VA and SCD has been the focus of intense research [4][5][6]. Cardiac magnetic resonance (CMR) will likely play a key role in the reassessment of risk-stratification in DCM, since late gadolinium enhancement (LGE) has consistently demonstrated a strong and independent association with VA and SCD in DCM [7][8][9][10][11].…”