The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up

2017 ◽  
pp. 573-580 ◽  
Author(s):  
Piotr Buchta ◽  
Mateusz Tajstra ◽  
Anna Kurek ◽  
Michał Skrzypek ◽  
Małgorzata Świetlińska ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Healthcare Costs ◽  
Cardiac Resynchronisation Therapy ◽  
Cardioverter Defibrillator ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
The Impact

scholarly journals Automatic daily remote monitoring in heart failure patients implanted with a cardiac resynchronisation therapy-defibrillator: a single-centre observational pilot study

2021 ◽  
Author(s):  
Peter Ezer ◽  
Nelli Farkas ◽  
Istvan Szokodi ◽  
Attila Kónyi
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Cardiac Resynchronisation Therapy ◽  
Office Visits ◽  
Single Centre ◽  
Death Event ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
The Impact

IntroductionThe impact of remote monitoring (RM) on clinical outcomes in heart failure (HF) patients with cardiac resynchronisation therapy-defibrillator (CRT-D) implantation is controversial. This study sought to evaluate the performance of an RM follow-up protocol using modified criteria of the PARTNERS HF trial in comparison with a conventional follow-up scheme.Material and methodsWe compared cardiovascular (CV) mortality (primary endpoint) and hospitalisation events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted patients with automatic RM utilising daily transmissions (RM group, n = 45) and conventional follow-up (CFU group, n = 43) in a single-centre observational study.ResultsAfter a median follow-up of 25 months, a significant advantage was seen in the RM group in terms of CV mortality (1 vs. 6 death event, p = 0.04), although RM follow-up was not an independent predictor for CV mortality (HR = 0.882; 95% CI: 0.25–3.09; p = 0.845). Patient CV mortality was independently influenced by hospitalisation events for decompensated HF (HR = 3.24; 95% CI: 8–84; p = 0.022) during follow-up. We observed significantly fewer hospitalisation events for decompensated HF (8 vs. 29 events, p = 0.046) in the RM group. Furthermore, a decreased number of total (161 vs. 263, p < 0.01) and unnecessary ambulatory in-office visits (6 vs.19, p = 0.012) were seen in the RM group as compared to the CFU group.ConclusionsFollow-up of CRT-D patients using automatic RM with daily transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival. Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional follow-up.

scholarly journals DIAGNOSIS OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OR CARDIAC RESYNCHRONISATION THERAPY.

2021 ◽  
Author(s):  
Barbara Dominik ◽  
Mitkowski Przemyslaw ◽  
Wojciech Zorawski ◽  
Ilona Kowalik ◽  
Adam Ciesielski
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronisation Therapy ◽  
Predisposing Factors ◽  
Study Group ◽  
Cardioverter Defibrillator ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

IntroductionImplantable cardioverter defibrillators register various types of arrhythmias. Thus they can be exploited to better identify patients with atrial fibrillation episodes and increase the proportion of patients who may benefit from implementation of pharmacological prophylaxis of thromboembolic events, most of which it turns out are asymptomatic.Material and methodsAssessment of the frequency, symptoms and predisposing factors for the occurrence of atrial fibrillation episodes in patients with implanted ICD (implantable cardioverter defibrillator) and CRT-D (cardiac resynchronisation therapy with defibrillator) based on the analysis of intracardiac electrocardiograms (IEGM) records. The study included 174 consecutive outpatient cases with heart failure, sinus rhythm and Implanted Cardioverter Defibrillator and Cardiac Resynchronisation Therapy with Defibrillator. Control visits with analysis of IEGM records occurred every three months. During mean follow-up of 20 months, 901 visits were carried out. 147 patients had at least one year of follow-up.ResultsAtrial fibrillation episodes in the study group occurred in 54 (31.0%) of patients and 71.4% were asymptomatic. Predisposing factors were: history of paroxysmal atrial fibrillation (37.0% vs 13.3%, p ˂ 0.001), atrioventricular conduction abnormalities (42.6% vs. 20.0%, p = 0.002), intraventricular conduction abnormalities (59.3% vs 40.8%, p = 0.02) and more severe mitral regurgitation (7.4% vs 0.8%, p = 0.04). Chronic renal disease was a risk factor for death in the study group. No stroke occurred during the study.ConclusionsEpisodes of paroxysmal AF in patients with systolic heart failure and implanted cardioverter-defibrillator systems are quite common. The majority of the episodes recorded in the study were asymptomatic.

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy – The Piece of a Much Larger Puzzle

2020 ◽  
Vol 18 ◽  
Author(s):  
Agnieszka Dębska-Kozłowska ◽  
Izabela Warchoł ◽  
Marcin Książczyk ◽  
Andrzej Lubiński
Keyword(s):  
Renal Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronisation Therapy ◽  
Study Groups ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Background: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of heart failure (HF) patients, the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. Objectives: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. Materials and methods: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to New York Heart Association (NYHA) class improvement ≥1. Results: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKD-EPI (63 ml/min/1.73m2 ) were empirically evaluated to predict favourable therapeutic CRT response. Conclusions: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT were found relevant.

P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Barbieri ◽  
A Adukauskaite ◽  
A Heidbreder ◽  
E Brandauer ◽  
M Bergmann ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Right Ventricular Pacing ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Abstract Funding Acknowledgements ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA Background Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA. Methods Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) &gt; 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design. Results CSA (AHI &gt; 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI &gt; 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p &lt; 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p &lt; 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up. Conclusions CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator. Abstract Figure.

Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy

2016 ◽  
Vol 23 (4) ◽  
pp. 470-475
Author(s):  
Francesco MA Brasca ◽  
Jessica Franzetti ◽  
Valeria Rella ◽  
Gabriella Malfatto ◽  
Roberto Brambilla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Area Under The Curve ◽  
Cardiac Resynchronisation Therapy ◽  
Failure Criteria ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Cardiac Resynchronisation ◽  
Acute Decompensation ◽  
Resynchronisation Therapy

Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1–67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728–0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90–7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

scholarly journals Cardiac resynchronisation therapy in Chagas disease: results in 82 pp during 2 years of follow-up

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3201-P3201
Author(s):  
J. R. Castro Dorticos ◽  
J. R. Castro Dorticos ◽  
J. Velasco Pucci ◽  
S. Dos Santos Galvao Filho ◽  
L. Leite ◽  
...  
Keyword(s):  
Chagas Disease ◽  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy
Sign in / Sign up

Export Citation Format

Share Document