CIED-based remote monitoring in heart failure using the HeartLogic™ algorithm: Which patients benefit most?

Autor: van der Lande ACMH; Executive Board, Leiden University Medical Centre, Leiden, the Netherlands., Feijen M; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Egorova AD; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Beles M; Cardiovascular Research Centre Aalst, Department of Cardiology, OLV Clinic, Aalst, Belgium., van Bockstal K; Cardiovascular Research Centre Aalst, Department of Cardiology, OLV Clinic, Aalst, Belgium., Phagu AAS; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Schalij MJ; Executive Board, Leiden University Medical Centre, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Heggermont WA; Cardiovascular Research Centre Aalst, Department of Cardiology, OLV Clinic, Aalst, Belgium., Beeres SLMA; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: s.l.m.a.beeres@lumc.nl.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Nov 15; Vol. 415, pp. 132421. Date of Electronic Publication: 2024 Aug 03.
DOI: 10.1016/j.ijcard.2024.132421
Abstrakt: Background & Aims: Early identification of worsening HF enables timely adjustments to prevent hospitalization. Recent studies show the HeartLogic™ algorithm detects congestion and reduces HF events. However, it is unclear which patients benefit most. Therefore, this study aims to identify and characterize HF patients who benefit most from CIED-based remote monitoring with HeartLogic™.
Methods: In this multicenter retrospective study, patients with a CIED and HeartLogic™ algorithm under structured follow-up were included. Patients were classified as having "substantial benefit" or "no benefit" from monitoring.
Results: In total, 242 patients were included (male n = 190, 79%, median age 61 years [IQR 61-77]). Median follow-up was 1.2 years [IQR 1.1-2.7]. Among 378 alerts, 266 were true positive (70%) and 112 false positive (30%). Of the 242 patients, 69 (29%) were classified as having "substantial benefit", while 173 (71%) had "no benefit" from HeartLogic™ monitoring. Univariate and multivariate analysis showed that patients with "substantial benefit" had higher NYHA functional class (OR 2.64, P = 0.004), higher NT-ProBNP (OR 1.02, P = 0.003), higher serum creatinine (OR 1.10, P < 0.001), lower LVEF (OR 1.19, P = 0.004), more severe mitral regurgitation (OR 2.16, P = 0.006), higher right ventricular end diastolic volume (OR 1.05, P = 0.040), higher pulmonary artery pressures (OR 1.19, P = 0.003), and were more likely to use loop diuretics (OR 2.79, P = 0.001). Among patients with "substantial benefit," the positive predictive value (PPV) of HeartLogic™ to detect congestion was 92%.
Conclusion: The utilization of CIED-based HeartLogic™ driven HF care demonstrated pronounced efficacy, predominantly in patients exhibiting characteristics of HF at a more advanced disease stage.
Competing Interests: Declaration of competing interest The department of Cardiology of the LUMC reports receiving unrestricted research and educational grants from Boston Scientific Corporation, Medtronic, and Biotronik. The department of cardiology of OLV Aalst reports receiving research and educational grants from Boston Scientific, Medtronic, Biotronik, Abbott St Jude Medical, and Microport and an educational and research grant from Boston Scientific with reference number ISRRM11793. The funders were not involved in study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. ADE receives consultancy and speaker fees from Boston Scientific Corporation and Medtronic. SLMAB receives speaker fees from Boston Scientific Corporation and Medtronic. The other authors have no conflict of interest to declare.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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