SPC365

Telemonitoring in Heart failure management – the experience of a remote center

Session: Posters (Sessão 5 - Écran 2) - Arritmias 5 - Foco na Insuficiência Cardíaca
Speaker: M. Inês Barradas

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 09.4 Home and Remote Patient Monitoring
Session Type: Pósters Electrónicos
FP Number: ---
Authors: m. Inês Barradas; Fabiana Duarte; Luís Resendes de Oliveira; Cátia Serena; António Xavier Fontes; André Viveiros Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-family:Calibri"><span style="color:black">Background: Remote patient monitoring (RPM) is a new standard of care in Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) but its impact in clinical outcomes is still uncertain. In remote locations, HF management is even more challenging and RPM may be an important tool in identifying earlier signs of HF decompensation.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-family:Calibri"><span style="color:black">Purpose: To assess the impact of RPM in clinical outcomes, compared to usual standard of care in chronic HF patients with CIEDs and to access the accuracy of multisensor device-based algorithms in a remote center.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-family:Calibri"><span style="color:black">Methods: We retrospectively evaluated consecutive patients with HF and CIEDs admitted to our center, through clinical assessments and continuous&nbsp;RPM when available (two different telemonitoring&nbsp;systems were used). Two groups were defined: standard of care plus RPM (group 1) and usual standard of care (group 2). Primary outcome was defined as cardiovascular (CV) death and secondary outcome as HF hospitalizations. A subanalysis of patients with RPM and active multisensor algorithm was also performed.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-family:Calibri"><span style="color:black">Results:&nbsp;From 243 patients with&nbsp;HF and&nbsp;CIEDs, RPM was active in 145 (59,7%) patients (group 1) vs usual standard of care in 98 (40,3%) (group 2). Mean age was 66,95 &plusmn; 11,848 years, 73,5%&nbsp;were males and&nbsp;follow-up was&nbsp;52,34&nbsp;&plusmn;&nbsp;44,05 months. 126&nbsp;(51,9%) patients had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D),&nbsp;96 (39,5%) transvenous implantable cardioverter defibrillator (ICD) and 21 (8,6%) CRT pacemaker (CRT-P). The aetiology of HF was ischemic in 43,7% and idiopathic in 37,7%, mean left ventricular ejection fraction was 34,33&nbsp;&plusmn;&nbsp;19,98% and there were 1,12&nbsp;&plusmn;&nbsp;1,98 HF hospitalizations per patient. Patients in group 1 were younger (65,16&nbsp;&plusmn;&nbsp;12,57 vs 69,85&nbsp;&plusmn;&nbsp;10,00 years, p=0,010) and had fewer HF hospitalizations compared to usual standard of care patients (group 2) (0,70&nbsp;&plusmn;&nbsp;0,17 vs 1,67&nbsp;&plusmn;&nbsp;0,39; p=0,021).&nbsp; CV death occurred in 12 (4,9%) patients in total and was significantly lower in group 1 (2 (13,8%) vs 10 (10,2%), p=0,001). From the patients with RPM, 31 (25,6%) had active&nbsp;multisensory device-based algorithm from two different telemonitoring systems and from these, 72 alerts were identified. Each patient had 2,41&nbsp;&plusmn;&nbsp;2,557 alerts with mean duration of 34,52&nbsp;&plusmn;&nbsp;29,791 days each.&nbsp;The number of HF alerts and total alert days correlated with&nbsp;the number of FV or TV (r=0,487, p=0,007 and r=0,548, p=0,002, respectively for number of alerts and total alert days) and HF hospitalizations (r=0,505, p=0,032 and r=0,493, p=0,037, respectively).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-family:Calibri"><span style="color:black">Conclusions:&nbsp;In remote locations,&nbsp;the integration of RPM in clinical practice, was associated with reduced CV death. The use of specialized multisensory device-based algorithms in an organized network may help identify patients with higher arrhythmic risk and recognise earlier signs of HF decompensation, reducing the need for HF hospitalizations. </span></span></span></span></span></p>