scholarly journals Remote Monitoring with Appropriate Reaction to Alerts Was Associated with Improved Outcomes in Chronic Heart Failure: Results from the OptiLink HF Study

2020 ◽  
Author(s):  
Jan Wintrich ◽  
Valérie Pavlicek ◽  
Johannes Brachmann ◽  
Ralph Bosch ◽  
Christian Butter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Cardiovascular Death ◽  
Medical Intervention ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Decompensation ◽  
Clinical Events ◽  
Improved Outcomes ◽  
Cardioverter Defibrillators

Background - Impedance-based remote monitoring (RM) failed to reduce clinical events in the OptiLink HF trial. However, rates of alert-driven interventions triggered by intrathoracic fluid index threshold crossings (FTC) were low indicating physicians' inappropriate reactions to alerts. Methods - We separated appropriate from inappropriate contacts to FTC transmissions in the OptiLink HF trial. Appropriate contacts had to meet the following criteria: i) initial telephone contact within 2 working days after FTC transmission, ii) follow-up contacts according to study protocol, and iii) medical intervention initiated after FTC due to cardiac decompensation. We compared time to cardiovascular death or heart failure hospitalization between RM patients contacted appropriately or inappropriately and patients with usual care (UC). Results - In the RM group, at least one FTC alert was transmitted in 356 patients (70.5%; n=505). Of note, only 55.5% (n=758) of all transmitted FTCs (n=1365) were followed by an appropriate contact. While 113 patients (31.7%; n=356) have been contacted appropriately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an appropriate contact. Compared to UC, RM with appropriate contacts to FTC alerts independently reduced the risk of the primary endpoint (Hazard ratio, 0.61; 95% confidence interval 0.39-0.95; p=0.027). Conclusions - RM appropriate reactions to FTC alerts are associated with significantly improved clinical outcomes in patients with advanced HF and implantable cardioverter-defibrillators.

Subcutaneous and single-chamber transvenous defibrillators: a nationwide matched control study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Bodin ◽  
A Bisson ◽  
B Pierre ◽  
J Herbert ◽  
N Clementy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Cardiovascular Death ◽  
Implantable Cardioverter Defibrillators ◽  
Matched Cohort ◽  
Icd Implantation ◽  
Baseline Characteristics ◽  
Artery Disease ◽  
Cardioverter Defibrillators

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Background Subcutaneous implantable cardioverter–defibrillators (S-ICD) was designed to avoid complications of single-chamber transvenous implantable cardioverter-defibrillators (VVI ICD) by using an entirely extra-thoracic placement. Purpose Our objective was to compare outcomes following first VVI ICD or S-ICD implantation in an exhaustive nationwide matched cohort. Methods This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2010 to September 1, 2020, who underwent a VVI ICD or S-ICD implantation were included. Patients with a previous pacemaker or ICD or with a history of infective endocarditis were excluded. Multivariable analyses for clinical outcomes during the whole follow-up in the groups of interests were performed using a Cox model with all baseline characteristics and reporting hazard ratio. Owing to the non-randomized nature of the study, and considering for significant differences in baseline characteristics, propensity-score matching was also used to control for potential confounders of the treatment outcome relationship. Results 21,667 patients were included in the cohort, 19,493 patients had a transvenous VVI ICD and 2,174 had a subcutaneous ICD. Mean age was 61.2 ± 13.2 years in the VVI ICD group and 52.3 ± 17.5 years in the S-ICD goup. Coronary artery disease was present in 71.6% of patients with a VVI ICD and 48.2% of patients with a S-ICD. Mean follow-up was 28.8 ± 31.8 months. S-ICD patients had a significant higher rate of all-cause death (HR: 1.684, 95%CI: 1.309-2.165, p < 0.001). There were no significant differences in cardiovascular death (HR: 1.092, 95%CI: 0.697-1.711, p = 0.70) and infective endocarditis (HR: 0.354, 95%CI: 0.067-1.433, p = 0.15) between the two groups Using propensity score, 1,582 patients with VVI ICD were matched 1:1 with S-ICD patients. Mean follow-up was 4.5 ± 7.2 months. In the matched analysis, there were no significant differences in all-cause death (HR: 1.090, 95%CI: 0.728-1.633, p = 0.68) and cardiovascular death (HR: 1.167, 95%CI: 0.603-2.260, p = 0.65) between the two groups. A trend toward a lower risk of infective endocarditis in the S-ICD group was also observed without reaching significance (HR : 0.219, 95%CI: 0.047-1.017, p = 0.053). A sensitivity analysis in patients with coronary artery disease in the matched cohort was performed. Same trends were observed without significant differences in all-cause death and cardiovascular death. Conclusion Our nationwide study highlighted a higher risk of all-cause death in patients treated with subcutaneous which however was not statistically significant after propensity score matching. No differences regarding cardiovascular mortality was found. An interesting trend toward diminution of infective endocarditis was also observed without reaching significancy.

Abstract 16392: The Effect of Dapagliflozin on Anemia in Patients With Heart Failure and Reduced Ejection Fraction: An Analysis of DAPA-HF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kieran Docherty ◽  
Silvio E Inzucchi ◽  
Lars Kober ◽  
Mikhail Kosiborod ◽  
Anna Maria Langkilde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Placebo Treatment ◽  
Cardiovascular Death ◽  
Treatment Allocation ◽  
Reduced Ejection Fraction ◽  
Improved Outcomes ◽  
Patients With Heart Failure

Background: Anemia is common and associated with worse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We examined: 1) whether dapagliflozin corrected anemia in these patients, and 2) the effect of dapagliflozin on outcomes, in patients with or without anemia, in DAPA-HF. Methods: Anemia was defined as baseline hematocrit <39% in men and <36% in women (WHO). Correction of anemia was defined as two consecutive hematocrit measurements above these thresholds at any time during follow-up (follow-up visits: 2 weeks, 2 and 4 months and 4-monthly thereafter). The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Findings: Of the 4744 patients randomized in DAPA-HF, 4691 had a baseline hematocrit and 1032 were anemic (22.0%). Anemia was corrected in 62% of patients in the dapagliflozin group, compared with 41% of patients in the placebo group (odds ratio 2.37 [95% CI 1.84-3.04]; p<0.001). The effect of dapagliflozin on the primary outcome was consistent in anemic and non-anemic patients (HR 0.68 [95% CI 0.52-0.88] versus 0.76 [0.65-0.89]; P-interaction=0.44) [Figure]. A consistent benefit was also observed for the secondary outcomes, irrespective of anemia status t baseline. Patients with resolution of anemia had better outcomes than those with persisting anemia: rate of primary outcome 9.9 per 100 patient-years (95% CI 8.0-12.4) in those with resolution versus 24.1 per 100 patient-years (20.4-28.3) in those without anemia resolution. Interpretation: Anemia was common in patients in DAPA-HF and associated with worse outcomes. Resolution of anemia was associated with better outcomes than persistence of anemia, regardless of treatment allocation. Although dapagliflozin corrected anemia more often than placebo, treatment with dapagliflozin improved outcomes, irrespective of anemia status.

Remote Follow-Up of Implantable Cardioverter Defibrillators

2013 ◽  
pp. 162-172
Author(s):  
David L. Scher ◽  
Franco Naccarella ◽  
Zhang Feng ◽  
Giovanni Rinaldi
Keyword(s):  
Remote Monitoring ◽  
Clinical Information ◽  
Medical Industry ◽  
Implantable Cardioverter Defibrillators ◽  
Remote Monitoring System ◽  
Patients With Heart Failure ◽  
New Literature ◽  
Cardioverter Defibrillators ◽  
Monitoring Devices

In this chapter, the authors introduce some concepts about the remote follow-up of Implantable Cardioverter Defibrillators (ICD). Even if this type of remote monitoring system is relatively new, literature has demonstrated the utilization in clinical practice and during the last few years, the medical industry has provided different devices. Starting from the background, some models of utilizations are presented, focusing on the description of the main functions provided by some devices offered on the market. Next the motivations for which remote follow-up is needed are explored; a better management of the patient is described in several studies, and the integration of clinical information from monitoring devices in Electronic Medical Records is presented as the important step in order to provide comprehensive clinical information about the patient. Also, economic issues are shown. Then, some experiences realized in U.S. are explored, and at last, a number of questions are proposed to the discussion as contribution to the next research. Some Italian recent experiences in the field of remote monitoring and home care of patients with heart failure with and without implantable devices are reported.

scholarly journals Remote Monitoring of Heart Failure in Patients with Implantable Cardioverter-Defibrillators: Current Status and Future Needs

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3763
Author(s):  
Dominic A. M. J. Theuns ◽  
Sumant P. Radhoe ◽  
Jasper J. Brugts
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Point Of View ◽  
Cardiac Resynchronization ◽  
Current Status ◽  
Ambulatory Setting ◽  
Implantable Cardioverter Defibrillators ◽  
Frequent Monitoring ◽  
The Impact ◽  
Cardioverter Defibrillators

The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.

scholarly journals Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow‐up

2019 ◽  
Vol 42 (2) ◽  
pp. 120-129 ◽  
Author(s):  
Ivy Timmermans ◽  
Mathias Meine ◽  
Istvan Szendey ◽  
Johannes Aring ◽  
Javier Romero Roldán ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Patient Experiences ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillators
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