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

Autor: Santobuono VE; Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari 'Aldo Moro', Bari, Italy., Favale S; Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari 'Aldo Moro', Bari, Italy., D'Onofrio A; Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie', Monaldi Hospital, Naples, Italy., Manzo M; OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno, Italy., Calò L; Policlinico Casilino, Rome, Italy., Bertini M; University of Ferrara, S. Anna University Hospital, Ferrara, Italy., Savarese G; S. Giovanni Battista Hospital, Foligno, Italy., Santini L; 'Giovan Battista Grassi' Hospital, Rome, Italy., Dello Russo A; Università Politecnica delle Marche, 'Ospedali Riuniti', Ancona, Italy., Lavalle C; Policlinico Umberto I, Rome, Italy., Viscusi M; S. Anna e S. Sebastiano Hospital, Caserta, Italy., Amellone C; 'Maria Vittoria' Hospital, Turin, Italy., Calvanese R; Ospedale del Mare, ASL NA1, Naples, Italy., Arena G; Ospedale Civile Apuane, Massa, Italy., Pangallo A; 'Bianchi-Melacrino-Morelli' Hospital, Reggio Calabria, Italy., Rapacciuolo A; Policlinico Federico II, Naples, Italy., Porcelli D; S. Pietro Fatebenefratelli Hospital, Rome, Italy., Campari M; Boston Scientific Italia, Milan, Italy., Valsecchi S; Boston Scientific Italia, Milan, Italy., Guaricci AI; Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari 'Aldo Moro', Bari, Italy.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2023 Aug; Vol. 10 (4), pp. 2469-2478. Date of Electronic Publication: 2023 Jun 05.
DOI: 10.1002/ehf2.14416
Abstrakt: Aims: The 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 Results: The 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% CI: 0.03-0.05) OUT of the alert state, with an incidence rate ratio of 13.35 (95% CI: 8.83-20.51, P < 0.001). Among patient characteristics, atrial fibrillation (AF) on implantation (HR: 1.62, 95% CI: 1.27-2.07, P < 0.001) and chronic kidney disease (CKD) (HR: 1.53, 95% CI: 1.21-1.93, P < 0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT-D versus ICD implantation (HR: 1.03, 95% CI: 0.82-1.30, P = 0.775). Comparisons of the clinical event rates in the IN alert state with those in the OUT of alert state yielded incidence rate ratios ranging from 9.72 to 14.54 (all P < 0.001) in all groups of patients stratified by: CRT-D/ICD, AF/non-AF, and CKD/non-CKD. After multivariate correction, the occurrence of alerts was associated with cardiovascular hospitalization or death (HR: 1.92, 95% CI: 1.05-3.51, P = 0.036).
Conclusions: The burden of HeartLogic alerts was similar between CRT-D and ICD patients, while patients with AF and CKD seemed more exposed to alerts. Nonetheless, the ability of the HeartLogic algorithm to identify periods of significantly increased risk of clinical events was confirmed, regardless of the type of device and the presence of AF or CKD.
(© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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