scholarly journals Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic

Biology ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 120
Author(s):  
Matteo Ziacchi ◽  
Leonardo Calò ◽  
Antonio D’Onofrio ◽  
Michele Manzo ◽  
Antonio Dello Russo ◽  
...  

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Diemberger ◽  
F Guerra ◽  
L Calo" ◽  
A D"onofrio ◽  
M Manzo ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic algorithm combines data from multiple implantable cardioverter defibrillator (ICD) sensors (first and third heart sounds, intrathoracic impedance, respirations, night heart rate, and patient activity) to provide integrated data that may allow for detection of early signs of worsening HF. Purpose We examined whether the HeartLogic platform may elucidate behavioral changes that impact HF decompensation, and the possible consequences of home confinement caused by the COVID-19 pandemic. Methods The Italian lockdown was imposed from March 8th to May 18th. On March 8th 2020, the HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from January 1st to July 19th was divided in 3 phases: Pre-Lockdown (weeks 1-11), Lockdown (weeks 12-20), Post-Lockdown (weeks 21-29). Results Immediately after the implementation of stay at home orders (week 12) we observed a significant drop in median activity level (65min [36-103] in week 12 vs. 101min [61-140] in Pre-Lockdown; p < 0.001), while there was no difference in the other contributing sensors. The median composite HeartLogic index increased at the end of Lockdown (4.7 [1.3-10.2] in week 20 vs. 2.5 [0.7-7.0] in Pre-Lockdown; p = 0.019). The weekly rate of HeartLogic alerts was significantly higher during Lockdown (1.56 alerts/week/100pts, 95%CI:1.15-2.06; IRR = 1.71, p = 0.014) and Post-Lockdown (1.37 alerts/week/100pts, 95%CI:0.99-1.84; IRR = 1.50, p = 0.072) than that reported in Pre-Lockdown (0.91 alerts/week/100pts, 95%CI:0.64-1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers (Pre-Lockdown: 31%, Lockdown: 22%, Post-Lockdown: 28%), and the proportion of alerts fully managed remotely (i.e. no in-clinic visits) (Pre-Lockdown: 89%, Lockdown: 90%, Post-Lockdown: 88%). Conclusions The system was sensitive to the behavioral changes occurred during the lockdown, i.e. decrease in activity. However, the home confinement had no impact on the other sensors. The higher rate of HeartLogic alerts during lockdown and the increase in the median index after 8 weeks of home confinement suggest the worsening of the HF status, possibly explained by the behavioral changes. Nonetheless, the management of the HF detected events (actions performed and management strategy) was not impacted by the restrictions.


2020 ◽  
Author(s):  
MEI YANG ◽  
Xuping Li ◽  
John C. Morris III ◽  
Jinjun Liang ◽  
Abhishek J. Deshmukh ◽  
...  

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.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Qi Zheng ◽  
Sarah Goodlin

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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