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Remote Monitoring of Cardiac Implantable Electronic Devices for predicting Acute Clinical Decompensation Events in Heart Failure Patients
Session:
Sessão de Posters 39 - Insuficiência cardíaca: abordagem a longo prazo
Speaker:
MARIANA GOMES TINOCO
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Tinoco; Margarida Castro; Marta Mota; Luísa Pinheiro; Filipa Almeida; Silvia Ribeiro; Lucy Calvo; Bebiana Faria; Bernardete Rodrigues; Claudia Mendes; Victor Sanfins; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><u>Background</u>:</strong> Heart Failure (HF) patients are at constant risk of decompensation, and urgent hospital admissions can be life-threatening events. Monitoring biological variables can be an important mechanism to anticipate decompensations. TriageHF is a validated diagnostic algorithm tool available on Medtronic® Cardiac Implantable Electronic Devices that combines physiological data to stratify a patient's risk of HF hospitalization in the following 30 days in low, medium or high risk. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><u>Purpose:</u></strong> We aimed to evaluate the utility of TriageHF algorithm to predict the occurrence of Acute Clinical Decompensation Events (ACDE), including HF-related and non-HF cardiovascular related events, within a 30-day period in a population of HF patients with reduced ejection fraction.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><u>Methods</u>:</strong> We reviewed the transmissions received by the Medtronic® Carelink™ Network between August 2022 and July 2023. The Heart Failure Risk Status (HFRS) and the device parameters contributing to that risk, from the previous 30 days, were collected, along with the occurrence of ACDEs within 30 days.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><u>Results</u>:</strong> We retrospectively assessed 207 transmissions from the 64 patients included in the study. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Among the 93 medium HFRS transmissions, 16 (17.2%) resulted in ACDEs. For the 21 high HFRS transmissions, 10 (47.6%) resulted in ACDEs. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Considering the ACDEs, 60.7% were preceded by an alarm-initiated transmission. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Except for Heart Rate Variability, each diagnostic parameter demonstrated effectiveness in stratifying risk for ACDEs. (figure 1) Optivol® and the Combined Heart Rhythm showed independent association with ACDEs (p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Patients with medium and high HFRS were, respectively, 8.6 and 29.1 times more likely to experience an ACDE in the next 30 days than low risk patients. (figure 2)</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">A medium-high HFRS conferred a sensitivity of 92.9% and a NPV of 97.8% for an ACDE. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><u>Conclusion</u>:</strong> <span style="background-color:white">Our study expands the use of the TriageHF algorithm to predict ACDEs, including HF-related and non-HF cardiovascular events. Automatic alerts and high-risk status transmissions have been shown to be crucial in predicting ACDEs, so remote monitoring teams should prioritize these transmissions. However, medium-risk transmissions should not be underestimated, as they present an opportunity for medical interventions to prevent disease progression and hospitalizations. The high sensitivity and high NPV of a medium-high HFRS for ACDEs suggest that the TriageHF algorithm could be used as an initial screening method.</span></span></span></p>
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