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Medhi D, Kamidi SR, Mamatha Sree KP, Shaikh S, Rasheed S, Thengu Murichathil AH, Nazir Z. Artificial Intelligence and Its Role in Diagnosing Heart Failure: A Narrative Review. Cureus 2024; 16:e59661. [PMID: 38836155 PMCID: PMC11148729 DOI: 10.7759/cureus.59661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
Heart failure (HF) is prevalent globally. It is a dynamic disease with varying definitions and classifications due to multiple pathophysiologies and etiologies. The diagnosis, clinical staging, and treatment of HF become complex and subjective, impacting patient prognosis and mortality. Technological advancements, like artificial intelligence (AI), have been significant roleplays in medicine and are increasingly used in cardiovascular medicine to transform drug discovery, clinical care, risk prediction, diagnosis, and treatment. Medical and surgical interventions specific to HF patients rely significantly on early identification of HF. Hospitalization and treatment costs for HF are high, with readmissions increasing the burden. AI can help improve diagnostic accuracy by recognizing patterns and using them in multiple areas of HF management. AI has shown promise in offering early detection and precise diagnoses with the help of ECG analysis, advanced cardiac imaging, leveraging biomarkers, and cardiopulmonary stress testing. However, its challenges include data access, model interpretability, ethical concerns, and generalizability across diverse populations. Despite these ongoing efforts to refine AI models, it suggests a promising future for HF diagnosis. After applying exclusion and inclusion criteria, we searched for data available on PubMed, Google Scholar, and the Cochrane Library and found 150 relevant papers. This review focuses on AI's significant contribution to HF diagnosis in recent years, drastically altering HF treatment and outcomes.
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Affiliation(s)
- Diptiman Medhi
- Internal Medicine, Gauhati Medical College and Hospital, Guwahati, Guwahati, IND
| | | | | | - Shifa Shaikh
- Cardiology, SMBT Institute of Medical Sciences and Research Centre, Igatpuri, IND
| | - Shanida Rasheed
- Emergency Medicine, East Sussex Healthcare NHS Trust, Eastbourne, GBR
| | | | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, Quetta, PAK
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2
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Fácila Rubio L, Lozano-Granero C, Vidal-Pérez R, Barrios V, Freixa-Pamias R. New technologies for the diagnosis, treatment, and monitoring of cardiovascular diseases. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:88-96. [PMID: 37838182 DOI: 10.1016/j.rec.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 10/16/2023]
Abstract
Telemedicine enables the remote provision of medical care through information and communication technologies, facilitating data transmission, patient participation, promotion of heart-healthy habits, diagnosis, early detection of acute decompensation, and monitoring and follow-up of cardiovascular diseases. Wearable devices have multiple clinical applications, ranging from arrhythmia detection to remote monitoring of chronic diseases and risk factors. Integrating these technologies safely and effectively into routine clinical practice will require a multidisciplinary approach. Technological advances and data management will increase telemonitoring strategies, which will allow greater accessibility and equity, as well as more efficient and accurate patient care. However, there are still unresolved issues, such as identifying the most appropriate technological infrastructure, integrating these data into medical records, and addressing the digital divide, which can hamper patients' adoption of remote care. This article provides an updated overview of digital tools for a more comprehensive approach to atrial fibrillation, heart failure, risk factors, and treatment adherence.
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Affiliation(s)
- Lorenzo Fácila Rubio
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Universitat de València, Valencia, Spain.
| | - Cristina Lozano-Granero
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal y Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vidal-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (UAH), Madrid, Spain
| | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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3
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Jankowska EA, Andersson T, Kaiser-Albers C, Bozkurt B, Chioncel O, Coats AJS, Hill L, Koehler F, Lund LH, McDonagh T, Metra M, Mittmann C, Mullens W, Siebert U, Solomon SD, Volterrani M, McMurray JJV. Optimizing outcomes in heart failure: 2022 and beyond. ESC Heart Fail 2023. [PMID: 37060168 PMCID: PMC10375115 DOI: 10.1002/ehf2.14363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 04/16/2023] Open
Abstract
Although the development of therapies and tools for the improved management of heart failure (HF) continues apace, day-to-day management in clinical practice is often far from ideal. A Cardiovascular Round Table workshop was convened by the European Society of Cardiology (ESC) to identify barriers to the optimal implementation of therapies and guidelines and to consider mitigation strategies to improve patient outcomes in the future. Key challenges identified included the complexity of HF itself and its treatment, financial constraints and the perception of HF treatments as costly, failure to meet the needs of patients, suboptimal outpatient management, and the fragmented nature of healthcare systems. It was discussed that ongoing initiatives may help to address some of these barriers, such as changes incorporated into the 2021 ESC HF guideline, ESC Heart Failure Association quality indicators, quality improvement registries (e.g. EuroHeart), new ESC guidelines for patients, and the universal definition of HF. Additional priority action points discussed to promote further improvements included revised definitions of HF 'phenotypes' based on trial data, the development of implementation strategies, improved affordability, greater regulator/payer involvement, increased patient education, further development of patient-reported outcomes, better incorporation of guidelines into primary care systems, and targeted education for primary care practitioners. Finally, it was concluded that overarching changes are needed to improve current HF care models, such as the development of a standardized pathway, with a common adaptable digital backbone, decision-making support, and data integration, to ensure that the model 'learns' as the management of HF continues to evolve.
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Affiliation(s)
- Ewa A Jankowska
- Institute of Heart Diseases, Wrocław Medical University and University Hospital, Wrocław, Poland
| | | | | | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu' Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Centre for Cardiovascular Telemedicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk and University Hasselt, Genk, Belgium
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Departments of Epidemiology and Health Policy & Management, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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4
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Buttar C, Lakhdar S, Nso N, Guzman-Perez L, Dao T, Mahmood K, Hendel R, Lavie CJ, Collura G, Trandafirescu T. Meta-Analysis Comparing Outcomes of Remote Hemodynamic Assessment Versus Standard Care in Patients With Heart Failure. Am J Cardiol 2023; 192:79-87. [PMID: 36758268 DOI: 10.1016/j.amjcard.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 02/09/2023]
Abstract
In patients with congestive heart failure (CHF), remote hemodynamic monitoring can reduce heart failure exacerbation and mortality. In this study, we compared the effectiveness of remote hemodynamic monitoring with that of standard care in the management of patients with CHF. The remote monitoring group included 7,733 patients, and the control group included 7,567 patients. Chi-square test and I-square statistics were used to assess heterogeneity. Risk ratios (RRs) were calculated using fixed-effects and random-effects methods to determine the risk of all-cause hospitalization and CHF-related hospitalization (primary outcomes) and all-cause mortality and device outcomes (secondary outcomes). Pooled findings indicated a 7% lower risk of all-cause hospitalization in the remote monitoring group than that in the control group (RR 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.004). The results also revealed a 32% lower risk of CHF-related hospitalization in the remote monitoring group than that in the control group (RR 0.68, 95% CI 0.65 to 0.71, p <0.001). No statistically significant differences were noted between the groups in terms of all-cause mortality (RR 0.97, 95% CI 0.87 to 1.07, p = 0.53) and device outcomes (RR 1.23 95% CI 0.92 to 1.65, p = 0.16). These results provided evidence regarding the comparable effectiveness of remote CHF monitoring and routine care. The current evidence is insufficient to introduce remote hemodynamic CHF monitoring; however, our results suggest that the integration of telemonitoring systems with routine medical management may improve heart failure care.
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Affiliation(s)
- Chandan Buttar
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Sofia Lakhdar
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
| | - Nso Nso
- Department of Cardiology, University of Chicago, Illinois
| | - Laura Guzman-Perez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Tristan Dao
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Kiran Mahmood
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hendel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Giovina Collura
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Theo Trandafirescu
- Division of Critical Care Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
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5
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Zito A, Princi G, Romiti GF, Galli M, Basili S, Liuzzo G, Sanna T, Restivo A, Ciliberti G, Trani C, Burzotta F, Cesario A, Savarese G, Crea F, D'Amario D. Device-based remote monitoring strategies for congestion-guided management of patients with heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2022; 24:2333-2341. [PMID: 36054801 PMCID: PMC10086988 DOI: 10.1002/ejhf.2655] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/02/2022] [Accepted: 08/13/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Pre-clinical congestion markers of worsening heart failure (HF) can be monitored by devices and may support the management of patients with HF. We aimed to assess whether congestion-guided HF management according to device-based remote monitoring strategies is more effective than standard therapy. METHODS AND RESULTS A comprehensive literature research for randomized controlled trials (RCTs) comparing device-based remote monitoring strategies for congestion-guided HF management versus standard therapy was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and HF hospitalizations. Secondary endpoints included the individual components of the primary outcome. A total of 4347 patients from eight RCTs were included. Findings varied according to the type of parameters monitored. Compared with standard therapy, haemodynamic-guided strategy (4 trials, 2224 patients, 12-month follow-up) reduced the risk of the primary composite outcome (IRR 0.79, 95% CI 0.70-0.89) and HF hospitalizations (IRR 0.76, 95% CI 0.67-0.86), without a significant impact on all-cause death (IRR 0.93, 95% CI 0.72-1.21). In contrast, impedance-guided strategy (4 trials, 2123 patients, 19-month follow-up) did not provide significant benefits. CONCLUSION Haemodynamic-guided HF management is associated with better clinical outcomes as compared to standard clinical care.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Cesario
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Innovation Sprint Sprl, Brussels, Belgium
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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6
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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7
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Skibelund AK. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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8
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Polcz M, Huston J, Breed M, Case M, Leisy P, Schmeckpeper J, Vaughn L, Sobey JH, Brophy C, Lindenfeld J, Hocking K, Alvis B. Comparison of clinical symptoms and bioimpedance to pulmonary capillary wedge pressure in heart failure. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 15:100133. [PMID: 35600671 PMCID: PMC9119644 DOI: 10.1016/j.ahjo.2022.100133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022]
Abstract
Introduction Clinical symptoms of heart failure commonly include fatigue, edema, and shortness of breath. Unfortunately, clinical monitoring has proven unreliable in predicting congestion and the need for hospitalization. Biosensing wearables have been developed as a potential adjunct to clinical signs and symptoms to detect congestion before it becomes severe thus preventing a heart failure hospitalization. Hypothesis Clinical signs and symptoms of heart failure will correlate with thoracic bioimpedance measurements (ZOE®) and pulmonary capillary wedge pressure (PCWP). Methods One hundred and fifty-five subjects undergoing right heart catheterization (RHC) were prospectively enrolled. A Zo value (ohms) was obtained, jugular venous pressure (JVP) was estimated, edema graded, and shortness of breath (SOB) assessed in all subjects. RHC was performed by a scheduled cardiologist per routine. One-way ANOVA was performed to assess the relationship between variables. A Pearson correlation coefficient was used to compare the Zo value and PCWP. Results Neither estimated JVP (cmH2O) (p = 0.65, n = 110) nor edema scores (p = 0.12, n = 110) demonstrated a significant relationship to PCWP. The presence of subjective SOB also did not demonstrate a significant association with PCWP (p = 0.99, n = 110). There was no correlation between ZOE® and PCWP (r = -0.08, p = 0.56, n = 56). Conclusions These findings support the idea that traditional measures for monitoring heart failure patients are limited.
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Affiliation(s)
- Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica Huston
- Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Meghan Breed
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marisa Case
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Philip Leisy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Schmeckpeper
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lexie Vaughn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenna Helmer Sobey
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Colleen Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bret Alvis
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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9
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 777] [Impact Index Per Article: 388.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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10
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Implantable devices for heart failure monitoring. Prog Cardiovasc Dis 2021; 69:47-53. [PMID: 34838788 DOI: 10.1016/j.pcad.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022]
Abstract
Heart failure (HF) is associated with considerable morbidity and mortality. The increasing prevalence of HF and inpatient HF hospitalization has a considerable burden on healthcare cost and utilization. The recognition that hemodynamic changes in pulmonary artery pressure (PAP) and left atrial pressure precede the signs and symptoms of HF has led to interest in hemodynamic guided HF therapy as an approach to allow earlier intervention during a heart failure decompensation. Remote patient monitoring (RPM) utilizing telecommunication, cardiac implantable electronic device parameters and implantable hemodynamic monitors (IHM) have largely failed to demonstrate favorable outcomes in multicenter trials. However, one positive randomized clinical trial testing the CardioMEMS device (followed by Food and Drug Administration approval) has generated renewed interest in PAP monitoring in the HF population to decrease hospitalization and improve quality of life. The COVID-19 pandemic has also stirred a resurgence in the utilization of telehealth to which RPM using IHM may be complementary. The cost effectiveness of these monitors continues to be a matter of debate. Future iterations of devices aim to be smaller, less burdensome for the patient, less dependent on patient compliance, and less cumbersome for health care providers with the integration of artificial intelligence coupled with sophisticated data management and interpretation tools. Currently, use of IHM may be considered in advanced heart failure patients with the support of structured programs.
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Efficacy of remote physiological monitoring-guided care for chronic heart failure: an updated meta-analysis. Heart Fail Rev 2021; 27:1627-1637. [PMID: 34609716 DOI: 10.1007/s10741-021-10176-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Previous studies have reported contradictory findings on the utility of remote physiological monitoring (RPM)-guided management of patients with chronic heart failure (HF). Multiple databases were searched for studies that evaluated the clinical efficacy of RPM-guided management versus standard of care (SOC) for HF patients. The primary outcome was HF-related hospitalization (HFH). The secondary outcomes were all-cause mortality, cardiovascular-related (CV) mortality, and emergency department (ED) visits. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using a random-effects model. A total of 16 randomized controlled trials, including 8679 HF patients (4574 managed with RPM-guided therapy vs. 4105 managed with SOC), were included in the final analysis. The average follow-up period was 15.2 months. There was no significant difference in HFH rate between the two groups (RR: 0.94; 95% CI: 0.84-1.07; P = 0.36). Similarly, there were no significant differences in CV mortality (RR 0.86, 95% CI 0.73-1.02, P = 0.08) or in ED visits (RR 0.80, 95% CI 0.59-1.08, P = 0.14). However, RPM-guided therapy was associated with a borderline statistically significant reduction in all-cause mortality (RR: 0.88; 95% CI: 0.78-1.00; P = 0.05). Subgroup analysis based on the strategy of RPM showed that both hemodynamic and arrhythmia telemonitoring-guided management can reduce the risk of HFH (RR: 0.79; 95% CI: 0.64-0.97; P = 0.02) and (RR: 0.79; 95% CI: 0.67-0.94; P = 0.008) respectively. Our study demonstrated that RPM-guided diuretic therapy of HF patients did not reduce the risk of HFH but can improve survival. Hemodynamic and arrhythmia telemonitoring-guided management could reduce the risk of HF-related hospitalizations.
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Remote monitoring for heart failure using implantable devices: a systematic review, meta-analysis, and meta-regression of randomized controlled trials. Heart Fail Rev 2021; 27:1281-1300. [PMID: 34559368 PMCID: PMC8460850 DOI: 10.1007/s10741-021-10150-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
In heart failure (HF) patients, remote monitoring using implantable devices may be used to predict and reduce HF exacerbations and mortality. Data from randomized controlled trials (RCTs) was assessed to determine the effectiveness of implantable remote monitoring on the improvement of outcomes in HF patients. A systematic review and meta-analysis of RCTs testing remote monitoring versus standard of care for management of HF patients was performed. Primary endpoints were all-cause mortality and a composite of cardiovascular (CV) and HF hospitalizations. Rate ratios (RRs) and 95% confidence intervals (CI) were calculated. A secondary analysis tested for heterogeneity of treatment effect (HTE) comparing right ventricular/pulmonary pressure monitoring versus impedance-based monitoring on hospitalization. A regression analysis was performed using the mean follow-up time as the moderator on each primary endpoint. Eleven RCTs (n = 6196) were identified with a mean follow-up of 21.9 months. The mean age and reported ejection fraction were 64.1 years and 27.7%, respectively. Remote monitoring did not reduce mortality (RR 0.89 [95% CI 0.77, 1.03]) or the composite of CV and HF hospitalizations (RR 0.98 [0.81, 1.19]). Subgroup analysis found significant HTE for hospitalizations between those studies that used right ventricular/pulmonary pressure monitoring versus impedance-based monitoring (I2 = 87.1%, chi2 = 7.75, p = 0.005). Regression analysis found no relationship between the log rate ratio of remote monitoring’s effect on mortality, CV hospitalization or HF hospitalization, and mean follow-up time. Compared to standard of care, remote monitoring using implantable devices did not reduce mortality, CV, or HF hospitalizations. However, right ventricular/pulmonary pressure monitoring may reduce HF hospitalizations, which will need to be explored in future studies.
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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14
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2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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15
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42:3599-3726. [PMID: 34447992 DOI: 10.1093/eurheartj/ehab368] [Citation(s) in RCA: 4825] [Impact Index Per Article: 1608.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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18
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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19
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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20
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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21
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Wand AL, Russell SD, Gilotra NA. Ambulatory Management of Worsening Heart Failure: Current Strategies and Future Directions. Heart Int 2021; 15:49-53. [PMID: 36277316 PMCID: PMC9524605 DOI: 10.17925/hi.2021.15.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a highly prevalent and morbid disease in the USA. The chronic, progressive course of HF is defined by periodic exacerbations of symptoms, described as 'worsening heart failure' (WHF). Previously, episodes of WHF have required hospitalization for intravenous diuretics; however, recent innovations in care delivery models for patients with HF have allowed a transition from the acute care setting to the ambulatory setting. The development of remote monitoring strategies, including device-based algorithms and implantable haemodynamic monitoring systems, has facilitated more advanced surveillance of patients, aiming to prevent the clinical deterioration that leads to hospitalization. Additionally, the establishment of multidisciplinary HF clinics has provided the setting and resources for the outpatient treatment of WHF, specifically the administration of intravenous diuretics. Here we review the current state of ambulatory HF management, including mechanisms for patient monitoring and treatment, and outline future opportunities for outpatient management of this patient population.
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Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Adlung L, Cohen Y, Mor U, Elinav E. Machine learning in clinical decision making. MED 2021; 2:642-665. [DOI: 10.1016/j.medj.2021.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022]
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Cabral S. Wearable remote monitoring in heart failure care - where do we stand? Rev Port Cardiol 2021; 40:339-341. [PMID: 34187635 DOI: 10.1016/j.repce.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sofia Cabral
- Cardiology Department, Centro Hospitalar Universitário do Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Porto University, Portugal.
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Alotaibi S, Hernandez-Montfort J, Ali OE, El-Chilali K, Perez BA. Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2021; 25:469-479. [PMID: 32002732 DOI: 10.1007/s10741-020-09923-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aims to determine whether the use of remote monitoring (RM) in implantable cardiac devices decreases all-cause mortality and heart failure (HF)-related hospitalization. We sought to conduct a systematic review and a meta-analysis of published randomized controlled studies. The population is adult patients with a diagnosis of HF with implantable devices. The intervention is RM using implantable cardiac devices whether added or used alone compared to standard of care. The outcomes are HF-related hospitalization and all-cause mortality. Risk of bias was assessed using the criteria defined in the Revised Cochrane Collaboration's tool for assessment of risk of bias. Data were extracted and validity was assessed independently by two reviewers. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 14th of October 2019, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and clinicaltrials.gov. Only randomized controlled studies published in peer-reviewed journals with full format text in English of adult HF patients with a minimum follow-up of 6 months reporting mortality and/or hospitalization. Observational studies and studies that did not meet inclusion criteria were excluded. Thirteen randomized controlled studies that enrolled a total of 7015 patients were identified, 7 of which reported on all-cause mortality only and included 4460 patients. Compared with standard of care, the pooled relative risk (RR) of all-cause mortality and HF-related hospitalization in patients with RM compared to those receiving standard of care was 0.88 (95% confidence interval (CI) 0.69 to 1.11) and 0.95 (95% CI 0.78-1.16), respectively. In the subgroup analysis, using pulmonary pressure for RM was associated with a decrease in HF-related hospitalization (RR 0.73; 95% CI 0.60-0.88). RM showed benefit in reducing HF-related hospitalization when compared to standard of care only when using pulmonary pressure monitoring.
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Affiliation(s)
- Sultan Alotaibi
- Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, 23311, Saudi Arabia.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jaime Hernandez-Montfort
- Department of Health Policy, London School of Economics and Political Science, London, UK.,Cleveland Clinic Florida, Weston, FL, USA
| | - Omar E Ali
- Department of Health Policy, London School of Economics and Political Science, London, UK.,School of Medicine, Wayne State University, Detroit, MI, 48202, USA.,Medical Director of Cardiac Catheterization Laboratory, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Karim El-Chilali
- Department of Cardiovascular and Pulmonary Medicine, Prosper Hospital, Recklinghausen, Germany
| | - Bernardo A Perez
- Department of Health Policy, London School of Economics and Political Science, London, UK. .,Wellian Inc., 2060 Broadway B1, Boulder, CO, 80302, USA.
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25
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Cabral S. Wearable remote monitoring in heart failure care - where do we stand? Rev Port Cardiol 2021; 40:339-341. [PMID: 33722447 DOI: 10.1016/j.repc.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sofia Cabral
- Cardiology Department, Centro Hospitalar Universitário do Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Porto University, Portugal.
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Bekfani T, Fudim M, Cleland JGF, Jorbenadze A, von Haehling S, Lorber A, Rothman AMK, Stein K, Abraham WT, Sievert H, Anker SD. A current and future outlook on upcoming technologies in remote monitoring of patients with heart failure. Eur J Heart Fail 2021; 23:175-185. [PMID: 33111389 DOI: 10.1002/ejhf.2033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/21/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022] Open
Abstract
Heart failure is a major health and economic challenge in both developing and developed countries. Despite advances in pharmacological and device therapies for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure, their quality of life and exercise capacity are often persistently impaired, morbidity and mortality remain high and the health economic and societal costs are considerable. For patients with heart failure and preserved LVEF, diuretic management has an essential role for controlling congestion and symptoms, even if no intervention has convincingly shown to reduce morbidity or mortality. Remote monitoring might improve care delivery and clinical outcomes for patients regardless of LVEF. A great variety of innovative remote monitoring technologies and algorithms are being introduced, including patient self-managed testing, wearable devices, technologies either integrated into established clinically indicated therapeutic devices, such as pacemakers and defibrillators, or as stand-alone are in development providing the promise of further improvements in service delivery and clinical outcomes. In this article, we will discuss unmet needs in the management of patients with heart failure, how remote monitoring might contribute to future solutions, and provide an overview of current and novel remote monitoring technologies.
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Affiliation(s)
- Tarek Bekfani
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow and National Heart & Lung Institute, Imperial College, London, UK
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | | | | | | | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Medical School, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité - Medical School Berlin, Berlin, Germany
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Pezel T, Berthelot E, Gauthier J, Chong-Nguyen C, Iliou MC, Juillière Y, Galinier MC, De Groote P, Beauvais F, Bauer F, Vergeylen U, Gellen B, Raphael P, Bezard M, Ricci JE, Boiteux MC, Bonnefous L, Bodez D, Audureau E, Damy T. Epidemiological characteristics and therapeutic management of patients with chronic heart failure who use smartphones: Potential impact of a dedicated smartphone application (report from the OFICSel study). Arch Cardiovasc Dis 2021; 114:51-58. [DOI: 10.1016/j.acvd.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Despite the promise of remote patient monitoring (RPM), this technology remained underutilized secondary to a lack of data transparency and systems issues until the COVID-19 pandemic ushered in a new era of telehealth and virtual solutions out of necessity. This review will explore the data supporting the use of RPM via both implantable and wearable devices in the field of cardiology and the role of home monitoring using RPM in the era of COVID-19. RECENT FINDINGS RPM using implantable cardiac devices is a safe alternative to in-person only visits which leads to enhanced patient satisfaction and improved clinical outcomes. Consumer-grade wearable sensors have drastically expanded RPM capabilities from just the sickest cardiac patients to the entire population aiding in early diagnosis and real-time disease management. Home monitoring enabled by automated alert systems tailored specifically to the needs of the patient by the provider will be the cornerstone of a more continuous, patent-centric healthcare model.
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Affiliation(s)
- Jennifer C. Miller
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Devin Skoll
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
| | - Leslie A. Saxon
- University of Southern California’s Center for Body Computing, 12015 E Waterfront Dr, Los Angeles, CA 90094 USA
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Mortara A, Margonato D. Proactive management of heart failure by digital health: is monitoring of invasive pulmonary artery pressure the
Holy Grail
? Eur J Heart Fail 2020; 22:1920-1922. [DOI: 10.1002/ejhf.1966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Andrea Mortara
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
| | - Davide Margonato
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
- Department of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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Abstract
Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems.
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Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
- Corresponding author. Tel: +39 06 5225 2409, Fax: +39 06 5225 2465,
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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32
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Alvis BD, Polcz M, Huston JH, Hopper TS, Leisy P, Mishra K, Eagle SS, Brophy CM, Lindenfeld J, Hocking KM. Observational Study of Noninvasive Venous Waveform Analysis to Assess Intracardiac Filling Pressures During Right Heart Catheterization. J Card Fail 2019; 26:136-141. [PMID: 31574315 DOI: 10.1016/j.cardfail.2019.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Outpatient monitoring and management of patients with heart failure (HF) reduces hospitalizations and health care costs. However, the availability of noninvasive approaches to assess congestion is limited. Noninvasive venous waveform analysis (NIVA) uses a unique physiologic signal, the morphology of the venous waveform, to assess intracardiac filling pressures. This study is a proof of concept analysis of the correlation between NIVA value and pulmonary capillary wedge pressure (PCWP) and the ability of the NIVA value to predict PCWP > 18 mmHg in subjects undergoing elective right heart catheterization (RHC). PCWP was also compared across common clinical correlates of congestion. METHODS AND RESULTS A prototype NIVA device, which consists of a piezoelectric sensor placed over the skin on the volar aspect of the wrist, connected to a data-capture control box, was used to collect venous waveforms in 96 patients during RHC. PCWP was collected at end-expiration by an experienced cardiologist. The venous waveform signal was transformed to the frequency domain (Fourier transform), where a ratiometric algorithm of the frequencies of the pulse rate and its harmonics was used to derive a NIVA value. NIVA values were successfully captured in 83 of 96 enrolled patients. PCWP ranged from 4-40 mmHg with a median of 13 mmHg. NIVA values demonstrated a linear correlation with PCWP (r = 0.69, P < 0.05). CONCLUSIONS This observational proof-of-concept study using a prototype NIVA device demonstrates a moderate correlation between NIVA value and PCWP in patients undergoing RHC. NIVA, thus, represents a promising developing technology for noninvasive assessment of congestion in spontaneously breathing patients.
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Affiliation(s)
- Bret D Alvis
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN.
| | - Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica H Huston
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Phil Leisy
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Kelly Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Colleen M Brophy
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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Lindenfeld J, Abraham WT, Maisel A, Zile M, Smart F, Costanzo MR, Mehra MR, Ducharme A, Sears SF, Desai AS, Paul S, Sood P, Johnson N, Ginn G, Adamson PB. Hemodynamic-GUIDEd management of Heart Failure (GUIDE-HF). Am Heart J 2019; 214:18-27. [PMID: 31150790 DOI: 10.1016/j.ahj.2019.04.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
Affiliation(s)
- JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States
| | - Alan Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs San Diego Healthcare, San Diego, CA, United States
| | - Michael Zile
- Division of Cardiology, Department of Medicine, RHJ Department of Veterans Affairs Medical Center and the Medical University of South Carolina, Charleston, SC, United States
| | - Frank Smart
- Cardiovascular Center of Excellence, Department of Medicine, Division of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Samuel F Sears
- Department(s) of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Akshay S Desai
- Center for Advanced Heart Disease, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Paul
- Heart Function Program, Catawba Valley Cardiology, Conover, NC, United States
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34
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Effects of Telemonitoring and Hemodynamic Monitoring on Mortality in Heart Failure: a Systematic Review and Meta-analysis. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Brahmbhatt DH, Cowie MR. Remote Management of Heart Failure: An Overview of Telemonitoring Technologies. Card Fail Rev 2019; 5:86-92. [PMID: 31179018 PMCID: PMC6545972 DOI: 10.15420/cfr.2019.5.3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
Technological advances have enabled increasingly sophisticated attempts to remotely monitor heart failure. This should allow earlier identification of decompensation, better adherence to lifestyle changes and medication and interventions (such as diuretic dosage changes) that reduce the need for hospitalisation. This review discusses telemonitoring approaches in heart failure, and the evidence for their impact. It is not difficult to collect data remotely, but converting more data into better decision-making that improves the outcome of care is challenging. Policy-makers and technology companies are enthusiastic about the potential of digital technologies to transform healthcare and bring expertise to the patient, rather than the other way round, but guideline writers are not yet convinced, due to the lack of consistent findings in randomised trials.
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36
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Kato TS, Daimon M, Satoh T. Use of Cardiac Imaging to Evaluate Cardiac Function and Pulmonary Hemodynamics in Patients with Heart Failure. Curr Cardiol Rep 2019; 21:53. [PMID: 31076948 DOI: 10.1007/s11886-019-1138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Noninvasive hemodynamic assessments in patients with heart failure (HF) are essential for appropriate diagnosis and establishment of the best treatment strategies. Recently, the impact of pulmonary circulation and right ventricular function on prognosis in HF patients has drawn increasing attention. In this article, we explore the usefulness of cardiac imaging for hemodynamic assessments, mainly focusing on echocardiographic evaluation. RECENT FINDINGS The reliability of Doppler echocardiography as a noninvasive alternative to Swan-Ganz catheterization has been well investigated with higher than 80% accuracy for estimating pulmonary artery pressure. Strain measurement and three-dimensional echocardiography are useful for evaluating right ventricular function together with pulmonary circulation. The accuracy of analyzing left and right ventricular functions by cardiac computed tomography and cardiac magnetic resonate imaging has also been established. These modalities can provide myocardial tissue information and allow calculation of the extracellular volume fraction as well. According to the rapid improvement of technologies, cardiac imaging has become an essential tool for hemodynamic evaluation in HF management.
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Affiliation(s)
- Tomoko S Kato
- Department of Medicine, Division of Cardiology, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan. .,Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine, Kyorin University, Tokyo, Japan
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The Utility of a Wireless Implantable Hemodynamic Monitoring System in Patients Requiring Mechanical Circulatory Support. ASAIO J 2019; 64:301-308. [PMID: 28953199 DOI: 10.1097/mat.0000000000000670] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Proper timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients is not well established and is an area of intense interest. In addition, optimizing LVAD performance after implantation remains difficult and represents a significant clinical need. Implantable hemodynamic monitoring systems may provide physicians with the physiologic information necessary to improve the timing of LVAD implantation as well as LVAD performance when compared with current methods. The CardioMEMS Heart sensor Allows for Monitoirng of Pressures to Improve Outcomes in NYHA Class III heart failure patients (CHAMPION) Trial enrolled 550 previously hospitalized patients with New York Heart Association (NYHA) class III heart failure. All patients were implanted with a pulmonary artery (PA) pressure monitoring system and randomized to a treatment and control groups. In the treatment group, physicians used the hemodynamic information to make heart failure management decisions. This information was not available to physicians for the control group. During an average of 18 month randomized follow-up, 27 patients required LVAD implantation. At the time of PA pressure sensor implantation, patients ultimately requiring advanced therapy had higher PA pressures, lower systemic pressure, and similar cardiac output measurements. Treatment and control patients in the LVAD subgroup had similar clinical profiles at the time of enrollment. There was a trend toward a shorter length of time to LVAD implantation in the treatment group when hemodynamic information was available. After LVAD implantation, most treatment group patients continued to provide physicians with physiologic information from the hemodynamic monitoring system. As expected PA pressures declined significantly post LVAD implant in all patients, but the magnitude of decline was higher in patients with PA pressure monitoring. Implantable hemodynamic monitoring appeared to improve the timing of LVAD implantation as well as optimize LVAD performance when compared with current methods. Further studies are necessary to evaluate these findings in a prospective manner.
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38
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Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, Linssen GCM, Agema WRP, Anneveldt S, Lucas CMHB, Mannaerts HFJ, Wajon EMCJ, Dickstein K, Cramer MJ, Landman MAJ, Hoes AW, Rutten FH. Effectiveness of the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' and an e-health adjusted care pathway in patients with stable heart failure: results of the 'e-Vita HF' randomized controlled trial. Eur J Heart Fail 2018; 21:238-246. [PMID: 30485612 PMCID: PMC6607483 DOI: 10.1002/ejhf.1354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/18/2018] [Accepted: 10/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Efficient incorporation of e‐health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self‐care of (i) the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ on top of usual care, and (ii) an e‐health adjusted care pathway leaving out ‘in person’ routine HF nurse consultations in stable HF patients. Methods and results In a three‐group parallel‐randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions (
heartfailurematters.org website and an e‐health adjusted care pathway) to usual care. The primary outcome was self‐care measured with the European Heart Failure Self‐care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow‐up, the mean score on the self‐care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6–6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8– 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups. Conclusions Both the heartfailurematters.org website and an e‐health adjusted care pathway improved self‐care in HF patients on the short term, but not on the long term. Continuous updating of e‐health facilities could be helpful to sustain effects. Clinical Trial registration: ClinicalTrials.gov ID NCT01755988.
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Affiliation(s)
- Kim P Wagenaar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ilse Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Kenneth Dickstein
- Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Maarten J Cramer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marcel A J Landman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Koehler F, Koehler K, Deckwart O, Prescher S, Wegscheider K, Winkler S, Vettorazzi E, Polze A, Stangl K, Hartmann O, Marx A, Neuhaus P, Scherf M, Kirwan BA, Anker SD. Telemedical Interventional Management in Heart Failure II (TIM-HF2), a randomised, controlled trial investigating the impact of telemedicine on unplanned cardiovascular hospitalisations and mortality in heart failure patients: study design and description of the intervention. Eur J Heart Fail 2018; 20:1485-1493. [PMID: 30230666 DOI: 10.1002/ejhf.1300] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms, all of which necessitate close follow-up by health care providers. Lack of disease monitoring may result in increased mortality and more frequent hospital readmissions for decompensated HF. Remote patient management (RPM) in this patient population may help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a manifestation of HF decompensation. OBJECTIVE The objective of the present article is to describe the design of a new trial investigating the impact of RPM on unplanned cardiovascular hospitalisations and mortality in HF patients. METHODS The TIM-HF2 trial is designed as a prospective, randomised, controlled, parallel group, open (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. Eligible patients with HF are randomised (1:1) to either RPM + usual care or to usual care only and are followed for 12 months. The primary outcome is the percentage of days lost due to unplanned cardiovascular hospitalisations or all-cause death. The main secondary outcomes are all-cause and cardiovascular mortality. CONCLUSION The TIM-HF2 trial will provide important prospective data on the potential beneficial effect of telemedical monitoring and RPM on unplanned cardiovascular hospitalisations and mortality in HF patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01878630.
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Affiliation(s)
- Friedrich Koehler
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Kerstin Koehler
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Oliver Deckwart
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Sandra Prescher
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Sebastian Winkler
- Unfallkrankenhaus Berlin, Clinic for Internal Medicine, Berlin, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Andreas Polze
- Hasso Plattner Institute gGmbH, Digital Engineering Faculty, University Potsdam, Potsdam, Germany
| | - Karl Stangl
- Charité - Universitätsmedizin Berlin, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | | | | | - Petra Neuhaus
- University of Leipzig, Faculty of Medicine, Clinical Trial Centre Leipzig - KKS, Leipzig, Germany
| | - Michael Scherf
- GETEMED Medizin- und Informationstechnik AG, Teltow, Germany
| | - Bridget-Anne Kirwan
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Public Health, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin- Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité - Universitätsmedizin Berlin, Germany
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40
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Aktuelle Entwicklungen in der Telemedizin. Herz 2018; 43:364-366. [DOI: 10.1007/s00059-017-4597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022]
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41
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Mondritzki T, Boehme P, White J, Park JW, Hoffmann J, Vogel J, Kolkhof P, Walsh S, Sandner P, Bischoff E, Dinh W, Hüser J, Truebel H. Remote Left Ventricular Hemodynamic Monitoring Using a Novel Intracardiac Sensor. Circ Cardiovasc Interv 2018; 11:e006258. [PMID: 29748220 DOI: 10.1161/circinterventions.117.006258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) remains the most common reason for hospital admission in patients aged >65 years. Despite modern drug therapy, mortality and readmission rates for patients hospitalized with HF remain high. This necessitates further research to identify early patients at risk for readmission to limit hospitalization by timely adjustment of medical therapy. Implantable devices can monitor left ventricular (LV) hemodynamics and remotely and continuously detect the early signs of decompensation to trigger interventions and reduce the risk of hospitalization for HF. Here, we report the first preclinical study validating a new batteryless and easy to implant LV-microelectromechanical system to assess LV performance. METHODS AND RESULTS A miniaturized implantable wireless pressure sensor was adapted for implantation in the LV apex. The LV-microelectromechanical system sensor was tested in a canine model of HF. The wireless pressure sensor measurements were compared with invasive left heart catheter-derived measurements at several time points. During different pharmacological challenge studies with dobutamine or vasopressin, the device was equally sensitive compared with invasive standard procedures. No adverse events or any observable reaction related to the implantation and application of the device for a period of 35 days was observed. CONCLUSIONS Our miniaturized wireless pressure sensor placed in the LV (LV-microelectromechanical system) has the potential to become a new telemetric tool to earlier identify patients at risk for HF decompensation and to guide the treatment of patients with HF.
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Affiliation(s)
- Thomas Mondritzki
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.) .,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Philip Boehme
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Jason White
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jin Woo Park
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jessica Hoffmann
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Julia Vogel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Kolkhof
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Stuart Walsh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Sandner
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Hannover Medical School, Germany (P.S.)
| | - Erwin Bischoff
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Wilfried Dinh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Department of Cardiology, HELIOS Clinic Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany (W.D.)
| | - Jörg Hüser
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Hubert Truebel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
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Olivari Z, Giacomelli S, Gubian L, Mancin S, Visentin E, Di Francesco V, Iliceto S, Penzo M, Zanocco A, Marcon C, Anselmi M, Marchese D, Stafylas P. The effectiveness of remote monitoring of elderly patients after hospitalisation for heart failure: The renewing health European project. Int J Cardiol 2018; 257:137-142. [DOI: 10.1016/j.ijcard.2017.10.099] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/30/2017] [Accepted: 10/26/2017] [Indexed: 12/19/2022]
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Givertz MM, Stevenson LW, Costanzo MR, Bourge RC, Bauman JG, Ginn G, Abraham WT. Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2017; 70:1875-1886. [DOI: 10.1016/j.jacc.2017.08.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022]
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Bloom MW, Greenberg B, Jaarsma T, Januzzi JL, Lam CSP, Maggioni AP, Trochu JN, Butler J. Heart failure with reduced ejection fraction. Nat Rev Dis Primers 2017; 3:17058. [PMID: 28836616 DOI: 10.1038/nrdp.2017.58] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure is a global public health problem that affects more than 26 million people worldwide. The global burden of heart failure is growing and is expected to increase substantially with the ageing of the population. Heart failure with reduced ejection fraction accounts for approximately 50% of all cases of heart failure in the United States and is associated with substantial morbidity and reduced quality of life. Several diseases, such as myocardial infarction, certain infectious diseases and endocrine disorders, can initiate a primary pathophysiological process that can lead to reduced ventricular function and to heart failure. Initially, ventricular impairment is compensated for by the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, but chronic activation of these pathways leads to worsening cardiac function. The symptoms of heart failure can be associated with other conditions and include dyspnoea, fatigue, limitations in exercise tolerance and fluid accumulation, which can make diagnosis difficult. Management strategies include the use of pharmacological therapies and implantable devices to regulate cardiac function. Despite these available treatments, heart failure remains incurable, and patients have a poor prognosis and high mortality rate. Consequently, the development of new therapies is imperative and requires further research.
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Affiliation(s)
- Michelle W Bloom
- Division of Cardiology, Stony Brook University Medical Center, 101 Nicolls Road, HSC, T-16, Rm 080, Stony Brook, New York 11794-8167, USA
| | - Barry Greenberg
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
| | - Tiny Jaarsma
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Programme in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Medical School, Singapore
| | - Aldo P Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Jean-Noël Trochu
- l'institut du thorax, Centre Hospital-Universitaire de Nantes, Nantes, France.,Medical School, University of Nantes, Nantes, France.,INSERM UMR1087 and CIC 1413, Nantes, France
| | - Javed Butler
- Division of Cardiology, Stony Brook University Medical Center, 101 Nicolls Road, HSC, T-16, Rm 080, Stony Brook, New York 11794-8167, USA
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Greenhalgh T, A’Court C, Shaw S. Understanding heart failure; explaining telehealth - a hermeneutic systematic review. BMC Cardiovasc Disord 2017; 17:156. [PMID: 28615004 PMCID: PMC5471857 DOI: 10.1186/s12872-017-0594-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. METHODS Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. RESULTS Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. CONCLUSION The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Christine A’Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
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Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in “Real-World” Clinical Practice. J Am Coll Cardiol 2017; 69:2357-2365. [DOI: 10.1016/j.jacc.2017.03.009] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/20/2022]
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Heywood JT, Jermyn R, Shavelle D, Abraham WT, Bhimaraj A, Bhatt K, Sheikh F, Eichorn E, Lamba S, Bharmi R, Agarwal R, Kumar C, Stevenson LW. Impact of Practice-Based Management of Pulmonary Artery Pressures in 2000 Patients Implanted With the CardioMEMS Sensor. Circulation 2017; 135:1509-1517. [DOI: 10.1161/circulationaha.116.026184] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/06/2017] [Indexed: 12/28/2022]
Abstract
Background:
Elevated pulmonary artery (PA) pressures in patients with heart failure are associated with a high risk for hospitalization and mortality. Recent clinical trial evidence demonstrated a direct relationship between lowering remotely monitored PA pressures and heart failure hospitalization risk reduction with a novel implantable PA pressure monitoring system (CardioMEMS HF System, St. Jude Medical). This study examines PA pressure changes in the first 2000 US patients implanted in general practice use.
Methods:
Deidentified data from the remote monitoring Merlin.net (St. Jude Medical) database were used to examine PA pressure trends from the first consecutive 2000 patients with at least 6 months of follow-up. Changes in PA pressures were evaluated with an area under the curve methodology to estimate the total sum increase or decrease in pressures (mm Hg-day) during the follow-up period relative to the baseline pressure. As a reference, the PA pressure trends were compared with the historic CHAMPION clinical trial (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients). The area under the curve results are presented as mean±2 SE, and
P
values comparing the area under the curve of the general-use cohort with outcomes in the CHAMPION trial were computed by the
t
test with equal variance.
Results:
Patients were on average 70±12 years old; 60% were male; 34% had preserved ejection fraction; and patients were followed up for an average of 333±125 days. At implantation, the mean PA pressure for the general-use patients was 34.9±10.2 mm Hg compared with 31.3±10.9 mm Hg for CHAMPION treatment and 32.0±10.5 mm Hg for CHAMPION control groups. The general-use patients had an area under the curve of −32.8 mm Hg-day at the 1-month time mark, −156.2 mm Hg-day at the 3-month time mark, and −434.0 mm Hg-day after 6 months of hemodynamic guided care, which was significantly lower than the treatment group in the CHAMPION trial. Patients consistently transmitted pressure information with a median of 1.27 days between transmissions after 6 months.
Conclusions:
The first 2000 general-use patients managed with hemodynamic-guided heart failure care had higher PA pressures at baseline and experienced greater reduction in PA pressure over time compared with the pivotal CHAMPION clinical trial. These data demonstrate that general use of implantable hemodynamic technology in a nontrial setting leads to significant lowering of PA pressures.
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Affiliation(s)
- J. Thomas Heywood
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Rita Jermyn
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - David Shavelle
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - William T. Abraham
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Arvind Bhimaraj
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Kunjan Bhatt
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Fareed Sheikh
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Eric Eichorn
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Sumant Lamba
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Rupinder Bharmi
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Rahul Agarwal
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Charisma Kumar
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
| | - Lynne W. Stevenson
- From the Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, CA (J.T.H.); St. Francis Hospital, Roslyn, NY (R.J.); Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA (D.S.); The Ohio State University, Columbus (W.T.A.); Houston Methodist Hospital, TX (A.B.); Austin Heart Hospital, Austin, TX (K.B.); St. Rose Dominican Hospital, Las Vegas, NV (F.S.); Medical City of Dallas, TX (E.E.); First Coast Cardiovascular Institute, Jacksonville, FL (S.L.); Clinical
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Metra M. March 2017 at a glance: pathophysiology, imaging, biomarkers and devices. Eur J Heart Fail 2017; 19:299-300. [DOI: 10.1002/ejhf.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
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50
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Tavazzi L, Borer JS, Tavazzi G. Use and Disuse of Observational Research: The Case of Remote Monitoring in Heart Failure. Cardiology 2016; 137:14-19. [DOI: 10.1159/000453655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/28/2022]
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