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Zito A, Restivo A, Ciliberti G, Laborante R, Princi G, Romiti GF, Galli M, Rodolico D, Bianchini E, Cappannoli L, D'Oria M, Trani C, Burzotta F, Cesario A, Savarese G, Crea F, D'Amario D. Heart failure management guided by remote multiparameter monitoring: A meta-analysis. Int J Cardiol 2023; 388:131163. [PMID: 37429443 DOI: 10.1016/j.ijcard.2023.131163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Several implant-based remote monitoring strategies are currently tested to optimize heart failure (HF) management by anticipating clinical decompensation and preventing hospitalization. Among these solutions, the modern implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been equipped with sensors allowing continuous monitoring of multiple preclinical markers of worsening HF, including factors of autonomic adaptation, patient activity, and intrathoracic impedance. OBJECTIVES We aimed to assess whether implant-based multiparameter remote monitoring strategy for guided HF management improves clinical outcomes when compared to standard clinical care. METHODS A systematic literature research for randomized controlled trials (RCTs) comparing multiparameter-guided HF management versus standard of care 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 hospitalization events, whereas secondary endpoints included the individual components of the primary outcome. RESULTS Our meta-analysis included 6 RCTs, amounting to a total of 4869 patients with an average follow-up time of 18 months. Compared with standard clinical management, the multiparameter-guided strategy reduced the risk of the primary composite outcome (IRR 0.83, 95%CI 0.71-0.99), driven by statistically significant effect on both HF hospitalization events (IRR 0.75, 95%CI 0.61-0.93) and all-cause death (IRR 0.80, 95%CI 0.66-0.96). CONCLUSION Implant-based multiparameter remote monitoring strategy for guided HF management is associated with significant benefit on clinical outcomes compared to standard clinical care, providing a benefit on both hospitalization events and all-cause death.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary 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 Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marika D'Oria
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary 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 Pulmonary 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; CEO, Gemelli Digital Medicine & Health Srl, Rome, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary 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 Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
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Chen CK, Cheng LY, Hsu SW, Liao MT, Ku PW, Liu YB. Comparative Analysis of Physical Activity Detected via an External Accelerometer and Cardiac Implantable Electronic Devices. Front Cardiovasc Med 2022; 9:898086. [PMID: 35694655 PMCID: PMC9184442 DOI: 10.3389/fcvm.2022.898086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPhysical activity (PA) has become an important health issue for decades. Cardiovascular implantable electronic devices (CIEDs) have built-in PA-recording functions. We aimed to compare PA measurements using an external accelerometer (ActiGraph GT3X+) and internal accelerometers (Abbott, Biotronik, and Medtronic CIEDs).MethodsThis was a prospective, single-center observational study. The device-measured 7-day average PA was collected, and GT3X+ -measured 7-day average PA was used as the gold-standard, including all daily observations of activity. Pearson’s correlation coefficients were used to compare the correlations between GT3X+ -measured and CIED-measured PA. Bland-Altman plots were used to analyze measurement agreement, and intraclass correlation coefficients were used to analyze reliability.ResultsIn total, 720 patients treated with CIEDs were surveyed between November 2020 and April 2021, 60 of them were analyzed after patient screening by our protocol. Each manufacturer included 20 patients for the final analysis. The CIED-measured PAs of Abbott, Biotronik, and Medtronic were 3.0 ± 1.5, 2.6 ± 1.8, and 3.8 ± 2.5 h per day, respectively; the GT3X+ -measured PAs were 6.9 ± 2.8, 6.0 ± 2.4, and 6.4 ± 2.5 h per day, respectively. Moderate and significant correlations were found in patients using Abbott, Biotronik, and Medtronic CIEDs (r = 0.534, p = 0.015; r = 0.465, p = 0.039; r = 0.677, p = 0.001, respectively). Bland-Altman plots and intraclass correlation coefficients both showed a significant correlation and reliability between the average PA measured by GT3X+ and CIEDs (hours per day).ConclusionAlthough the PA recording function of CIEDs includes a single-axis accelerometer, it has a moderate correlation compared with the triaxial accelerometer of the GT3X+. However, CIEDs seem to underestimate PA for 3–4 h compared to the GT3X+.
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Affiliation(s)
- Chun-Kai Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Li-Ying Cheng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shan-Wei Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Min-Tsun Liao,
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, Taichung, Taiwan
| | - Yen-Bin Liu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Wakabayashi Y, Kobayashi M, Ichikawa T, Koyama T, Abe H. Association of device-measured physical activity with peak oxygen consumption measured by cardiopulmonary exercise testing in patients with cardiac implantable electronic devices. J Interv Card Electrophysiol 2021; 63:651-659. [PMID: 34826015 DOI: 10.1007/s10840-021-01095-8] [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: 06/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Cardiac implantable electronic devices (CIEDs) offer diagnostic information such as device-measured physical activity (PA). Peak oxygen consumption (VO2) measured by cardiopulmonary exercise testing (CPET) is the most objective variable showing exercise capacity. The purpose of this study was to investigate the relationship between these 2 variables. METHODS We retrospectively studied consecutive patients with CIEDs undergoing CPET between April 1, 2018, and January 31, 2021. These patients were divided into 2 groups: patients with peak VO2 ≤ 14 ml/kg/min (low peak VO2 group) and those showing peak VO2 > 14 ml/kg/min (high peak VO2 group). The peak device-measured PA was compared between the 2 groups. The relationship between the peak device-measured PA and peak VO2 was also investigated. RESULTS There were 50 and 51 patients in the low and high peak VO2 groups, respectively. The peak device-measured PA, which was expressed in units of hours/day, was significantly lower in the low peak VO2 group than in the high peak VO2 group (3.06, interquartile range [2.43-4.00] vs. 5.50, interquartile range [4.04-6.70] p < 0.01). The peak device-measured PA and peak VO2 showed a significant positive correlation (Spearman's ρ = 0.53; p < 0.01). Furthermore, receiver operating characteristic curve analysis showed that a peak device-measured PA > 3.87 h/day could predict high peak VO2 (80.4%, sensitivity; 72.0%, specificity). In multivariate linear regression analysis, peak device-measured PA was an independent predictor of peak VO2 (regression coefficient, 0.61; 95% confidence interval, 0.33-0.89; p < 0.01). CONCLUSIONS Peak device-measured PA was significantly associated with peak VO2.
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Affiliation(s)
- Yasushi Wakabayashi
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto City, Nagano, 390-8505, Japan.
| | - Masanori Kobayashi
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto City, Nagano, 390-8505, Japan
| | - Tomohide Ichikawa
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto City, Nagano, 390-8505, Japan
| | - Takashi Koyama
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto City, Nagano, 390-8505, Japan
| | - Hidetoshi Abe
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto City, Nagano, 390-8505, Japan
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