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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
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15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Remote monitoring alerts in heart failure patients: Which parameters matter most?
Session:
Painel 5- Arritmologia 4
Speaker:
Guilherme Portugal
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.4 Home and Remote Patient Monitoring
Session Type:
Posters
FP Number:
---
Authors:
Guilherme Portugal; Isabel Gonçalves Machado Cardoso; Madalena Coutinho Cruz; António Valentim Gonçalves; Ana Sofia Delgado; Pedro Silva Cunha; Bruno Tereno Valente; André Viveiros Monteiro; Inês Grácio De Almeida; Antonio; Mário Martins Oliveira; Rui Cruz Ferreira
Abstract
<p>Patients (P) submitted to cardiac ressynchronization therapy (CRT) are at high risk of heart failure (HF) events during follow-up. Analysis of various physiological parameters by remote monitoring (RM) may help signal heart failure decompensation; however, the value of individual alerts is unclear.</p> <p> </p> <p>Aim: To assess the incidence and predictive value of RM alerts on incident HF admissions</p> <p> </p> <p>Methods: Consecutive P submitted to CRT implantation between January 2013 and September 2019 who had regular RM transmissions were included.</p> <p>Assessed parameters were OptiVol (Medtronic Plc., MN, USA), patient activity, night heart rate (NHR), heart rate variability (HRV), percent CRT pacing, atrial tachycardia/atrial fibrillation (AT/AF) burden, ventricular rate during AT/AF (VRAF), and detected arrhythmia episodes/therapy delivered.</p> <p>Hospital admissions were systematically assessed by use of a national database ("Plataforma de Dados de Saúde").</p> <p>Association between RM alerts and HF admissions was assessed by use of univariate and multivariate logistic regression and receiving operator characteristic (ROC) curve analysis.</p> <p> </p> <p>Results: 1108 transmissions of 35 CRT P, corresponding to 94 patient-years were assessed. Mean follow-up was 2.7 yrs. At implant, age was 67.6 +/- 9.8 yrs, left ventricular ejection fraction 28 +/-7.8%, BNP 156.6+/- 292.8 and NYHA class>II in 46% of the P.</p> <p>At least one alert was observed in 84.4% of transmissions. The most common alert was reduction in HRV (44.2% of transmissions) followed by NHR (43.1%) and patient activity (34%).</p> <p>Individual predictors of HF events were BiV pacing, OptiVol and delivered device therapy (p<0.050 for all). Best discrimination was observed with BiV pacing (AUC 0.92) followed by OptiVol (AUC 0.79) and heart rate variability (AUC 0.67). Accuracy of RM alerts was increased by the association of all reported parameters which yielded the best discrimination for HF events (OR 7.8, CI 3.5-16-9, p<0.001, AUC 0.95)</p> <p> </p> <p>Conclusions:</p> <p>Individual RM parameter alerts are common and usually not linked with HF events. Rather than individual alerts, simultaneous shift in multiple RM parameters may be the most reliable predictor of incident HF.</p>
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