TIMING AND MODE OF 2.0 AMPERE HOUR CARDIAC RESYNCHRONIZATION IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OUT OF SERVICE IN A LARGE COMMUNITY HOSPITAL HEART FAILURE COHORT

Abstract Background The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator (ICD)-based sensors into an index for prediction of impending heart failure (HF) decompensation. In patients with ICD and cardiac resynchronization therapy ICD remotely monitored at 13 Spanish centers, we analyzed the association between clinical events and HeartLogic alerts and we described the use of the algorithm for the remote management of HF. Methods The association between clinical events and HeartLogic alerts was studied in the blinded phase (from ICD implantation to alert activation – no clinical actions taken in response to alerts) and in the following active phase (after alert activation – clinicians automatically notified in case of alert). Results We enrolled a total of 215 patients (67±13 years old, 77% male, 53% with ischemic cardiomyopathy) with ICD (19%) or CRT-D (81%). The median duration of the blinded phase was 8 [3–12] months. In this phase, the HeartLogic index crossed the threshold value (set by default to 16) 34 times in 20 patients. HeartLogic alerts were associated with 6 HF hospitalizations and 5 unplanned in-office visits for HF. Five additional HeartLogic threshold crossings were not associated with overt HF events, but occurred at the time of changes in drug therapy or of other clinical events. The rate of unexplained alerts was 0.25 alert-patient/year. The median time spent in alert was longer in the case of HF hospitalizations than of in-office visits (75 [min-max: 30–155] days versus 39 [min-max: 5–105] days). The maximum HeartLogic index value was 38±15 in the case of hospitalizations and 24±7 in that of minor HF events. The median duration of the following active phase was 5 [2–10] months. After HeartLogic activation, 40 alerts were reported in 26 patients. Twenty-seven (68%) alerts were associated with multiple HF- or non-HF related conditions or changes in prescribed HF therapy. Multiple actions were triggered by these alerts: HF hospitalization (4), unscheduled in-office visits (8), diuretics increase (8), change in other cardiovascular drugs (5), device reprogramming (2), atrial fibrillation ablation (1), patient education on therapy adherence (2). The rate of unexplained alerts not followed by any clinical action was 0.13 alert-patient/year. These alerts were managed remotely (device data review and phone contact), except for one alert that generated an unscheduled in-office visit. Conclusions HeartLogic index was frequently associated with HF-related clinical events. The activation of the associated alert allowed to remotely detect relevant clinical conditions and to implement clinical actions. The rate of unexplained alerts was low, and the work required in order to exclude any impending decompensation did not constitute a significant burden for the centers. Funding Acknowledgement Type of funding source: None

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Outcomes of Cardiac Resynchronization Therapy in Patients with Hypothyroidism and Heart Failure

10.21203/rs.3.rs-23073/v2 ◽

2020 ◽

Author(s):

MEI YANG ◽

Xuping Li ◽

John C. Morris III ◽

Jinjun Liang ◽

Abhishek J. Deshmukh ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Implantable Cardioverter Defibrillator ◽

Hazard Ratio ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Therapy Outcomes ◽

Implantable Cardioverter Defibrillator Therapy ◽

Cardioverter Defibrillator ◽

All Cause Mortality

Abstract Background Hypothyroidism is known to be associated with adverse clinical outcomes in heart failure. The association between hypothyroidism and cardiac resynchronization therapy outcomes in patients with severe heart failure is not clear. Methods The study included 1,316 patients who received cardiac resynchronization therapy between 2002 and 2015. Baseline demographics and cardiac resynchronization therapy outcomes, including left ventricular ejection fraction, New York Heart Association class, appropriate implantable cardioverter-defibrillator therapy, and all-cause mortality, were collected from the electronic health record. Results Of the study cohort, 350 patients (26.6%) were classified as the hypothyroidism group. The median duration of follow-up was 3.6 years (interquartile range, 1.7-6.2). Hypothyroidism was not associated with a higher risk of all-cause mortality in patients receiving CRT for heart failure. The risk of appropriate implantable cardioverter-defibrillator therapy significantly increased in association with increased baseline thyroid -stimulating hormone level in the entire cohort (hazard ratio, 1.23 per 5mIU/L increase; 95% CI, 1.01-1.5; P=0.04) as well as in the hypothyroid group (hazard ratio, 1.44 per 5mIU/L increase; 95% CI, 1.13-1.84; P=0.004). Conclusions CRT improves cardiac function in hypothyroid patients. The ventricular arrhythmic events requiring ICD therapies are associated with baseline TSH level, which might be considered as an important biomarker to stratify the risk of sudden death for patients with heart failure and hypothyroidism.

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Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: changes from 2004 to 2008

European Journal of Heart Failure ◽

10.1093/eurjhf/hfp149 ◽

2009 ◽

Vol 11 (12) ◽

pp. 1143-1151 ◽

Cited By ~ 102

Author(s):

Dirk J. van Veldhuisen ◽

Alexander H. Maass ◽

Silvia G. Priori ◽

Pelle Stolt ◽

Isabelle C. van Gelder ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Device Therapy ◽

Cardioverter Defibrillator ◽

Patients With Heart Failure

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Abstract 17488: What Are the Gaps? A Qualitative Study on Patient and Family Decision Making Regarding Implantable Cardioverter Defibrillator and Cardiac Resynchronization Therapy

Circulation ◽

10.1161/circ.142.suppl_3.17488 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Qi Zheng ◽

Sarah Goodlin

Keyword(s):

Heart Failure ◽

Decision Making ◽

Qualitative Study ◽

Cardiac Resynchronization Therapy ◽

Functional Status ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardioverter Defibrillator ◽

Life Style Changes

Background: Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT-D) reduce mortality and improve functional status in selected patients with heart failure (HF). However, there are potential procedural risks and psychosocial concerns associated with device implant. This qualitative study aims to explore patients’ and families’ understanding of ICD/CRT-D, heart failure and arrhythmia in the process of decision making regarding device implant. Methods: We conducted 14 focus groups or interviews in Salt Lake City UT and Silver Spring MD. This study included 23 patients, who had either an ICD or CRT-D implant for primary prevention, and 14 family members. Grounded theory analysis was performed to reach a conceptual understanding of patients’ and families’ perceptions and needs. Results: Patients and families largely made decision of ICD/CRT implant based on physicians’ recommendations, e.g. “I really try to do what they tell me to do” (icdpt 1). Patients perceived ICD as lifesaving and CRT being helpful to improve functional status. Many patients described ICD as lifesaving by “restarting a heart if it stops”, while did not understand HF or ventricular arrhythmia. Patients perceived an urgency to consider ICD implant from their physicians, but no such urgency was perceived when they discussed about CRT-D implant. Few participants were concerned with costs, or had knowledge of potential lead malfunction, device removal and associated risks. Many emphasized the importance of information about life expectancies, what HF is, options of different devices, complications and precautions, and what to expect regarding lifestyle changes. Conclusion: Patients and families largely relied on the information provided by physicians and followed physicians’ guidance. They had limited understanding of their prognosis, HF and arrhythmia, and they were motivated to learn. Discussion about devices should include prognosis and healthy life style changes.

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