Refined heart failure detection algorithm for improved clinical reliability of OptiVol alerts in CRT-D recipients

Vámos, Máté; Nyolczas, Noémi; Bári, Zsolt; Bogyi, Peter; Muk, Balázs; Szabó, Barna; Ancsin, Bettina; Kiss, Róbert Gábor; Duray, Gabor Z.

doi:10.5603/cj.a2017.0077

Cited by 15 publications

(24 citation statements)

References 19 publications

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“…The story of RM using devices has progressed from singlephysiological parameter data to sophisticated combined algorithms. 10,18,19 Partners HF used multiple physiological parameters as part of a combined device-based diagnostic algorithm to identify patients at increased risk of heart events in the next 30 days. 10 However, despite promising results from subsequent retrospective analyses, the failure to demonstrate impact on hard outcomes as presented in REM-HF and MORE-CARE was disappointing and threatened to close the door on this avenue of care.…”

Section: Discussionmentioning

confidence: 99%

Triage‐HF Plus: a novel device‐based remote monitoring pathway to identify worsening heart failure

et al. 2019

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Aims Remote monitoring of patients with physiological data derived from cardiac implanted electronic devices (CIEDs) offers potential to reconfigure clinical services. The ‘Heart Failure Risk Score' (HFRS) uses input from integrated device physiological monitoring to risk‐stratify patients as low‐risk, medium‐risk, or high‐risk of a heart failure event in the next 30 days. This study aimed to evaluate a novel clinical pathway utilizing a combination of CIED risk‐stratification and telephone triage to identify patients with worsening heart failure (WHF). Methods and results A prospective, single‐centre, real‐world evaluation of the ‘Triage‐HF Plus' clinical pathway (HFRS in combination with telephone triage) over a 27 month period. One hundred and fifty‐seven high‐risk HFRS transmissions were referred for telephone triage assessment. Interventions were at the discretion of the clinical assessor acting in accordance with clinical guidelines. An additional 3month consecutive sample of low and medium HFRS transmissions (control group) were also contacted for telephone triage assessment (n = 98). Successful telephone contact was made in 127 (81%) of referred high‐risk HFRS cases: 71 (55.9%) were confirmed to have WHF requiring intervention; 19 (14.9%) had an alternative acute medical problem; one patient had been recently discharged from hospital with WHF; and 36 (28.0%) had no apparent cause for the high score. In the control group, only one patient had symptoms of WHF. The sensitivity and specificity of CIED‐based remote monitoring to identify WHF 98.6% (92.5–100.0%) and 63.4% (55.2–71.0%), respectively. Conclusions The Triage‐HF Plus clinical pathway is a potentially useful remote monitoring tool for patients with heart failure and in situ CIEDs.

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Section: Discussionmentioning

confidence: 99%

Triage‐HF Plus: a novel device‐based remote monitoring pathway to identify worsening heart failure

et al. 2019

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“…This method, used for the detection of cardiac decompensation, is considered to be a very sensitive but less specific tool, which leads to a high number of false positive alerts. We have previously described a refined device diagnostic algorithm based on parameters of low activity level, high nocturnal heart rate, and suboptimal biventricular pacing, which could significantly improve clinical reliability of OptiVol alerts [9]. However, a recent OptiLink heart failure study analyzing this technology failed to demonstrate any difference in the composite endpoint of all-cause mortality and cardiovascular hospitalization [29].…”

Section: Discussionmentioning

confidence: 99%

“…Randomized studies proved that remote monitoring could reduce time to evaluate arrhythmic events [3], decrease mean length of cardiovascular hospitalizations [4], and could significantly lower the number of appropriate or inappropriate shocks [5]. This method is also able to reduce in-office implantable cardioverter defibrillator (ICD) follow-up burden safely [6] Remote monitoring also provided early detection of heart failure events and reduced the number of urgent in-office visits and total health care use in patients with ICD or cardiac resynchronization systems in diverse clinical studies [7-9].…”

Section: Introductionmentioning

confidence: 99%

Association of Remote Monitoring With Survival in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy: Retrospective Observational Study

et al. 2019

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Background Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory. Objective The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center. Methods The population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up. Results The mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P =.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P =.004). Conclusions In this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate.

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“…Implantable devices to measure fluid status also exist, but such devices have yet to be evaluated in cardiorenal syndrome setting. One study showed the use of OptiVol (Medtronic), an intrathoracic impedance monitor, to improve heart failure prognosis, but had little effect on hospital admissions and outpatient visits despite utilization of visit alerts (Vamos et al, 2018). Pulmonary artery catheterization is no longer used clinically as it had demonstrated no benefit on mortality and rehospitalization in acute heart failure (Binanay et al, 2005), but it might be useful to detect and treat subclinical congestion (Rangaswami et al, 2019).…”

Section: Diagnosis Prognosis and Treatment Of Cardiorenal Syndromementioning

confidence: 99%

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

Savira

Magaye

Liew

et al. 2020

British J Pharmacology

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Cardiorenal syndrome (CRS) is a multi-organ disease, encompassing heart, kidney and vascular system dysfunction. CRS is a worldwide problem, with high morbidity, mortality, and inflicts a significant burden on the health care system. The pathophysiology is complex, involving interactions between neurohormones, inflammatory processes, oxidative stress and metabolic derangements. Therapies remain inadequate, mainly comprising symptomatic care with minimal prospect of full recovery. Challenges include limiting the contradictory effects of multi-organ targeted drug prescriptions and continuous monitoring of volume overload. Novel strategies such as multi-organ transplantation and innovative dialysis modalities have been considered but lack evidence in the CRS context. The adjunct use of pharmaceuticals targeting alternative pathways showing positive results in preclinical models also warrants further validation in the clinic. In recent years, studies have identified the involvement of gut dysbiosis, uraemic toxin accumulation, sphingolipid imbalance and other unconventional contributors, which has encouraged a shift in the paradigm of CRS therapy.

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Refined heart failure detection algorithm for improved clinical reliability of OptiVol alerts in CRT-D recipients

Abstract: (Cardiol J 2018; 25, 2: 236-244)

Cited by 15 publications

References 19 publications

Triage‐HF Plus: a novel device‐based remote monitoring pathway to identify worsening heart failure

Triage‐HF Plus: a novel device‐based remote monitoring pathway to identify worsening heart failure

Association of Remote Monitoring With Survival in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy: Retrospective Observational Study

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

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