Incidence and Predictors of Progression in Asymptomatic Patients With Stable Heart Failure

Native QRS duration and outcomes in heart failure with mildly reduced ejection fraction: results from a large-scaled registry

OBJECTIVE

The study investigates the prognostic impact of the native QRS duration in patients with heart failure and mildly reduced ejection fraction (HFmrEF).

BACKGROUND

The prognostic impact of QRS duration in HFmrEF has rarely been investigated.

METHODS

Consecutive patients with HFmrEF and available 12-lead electrocardiogram were retrospectively included at one institution from 2016 to 2022. Patients with QRS duration ≥ 120 ms were compared to patients with QRS duration < 120 ms, further risk stratification was performed comparing patients with left and right bundle branch block (LBBB vs. RBBB). The primary endpoint was all-cause mortality at 30 months, secondary endpoints comprised the risk of HF-related rehospitalization.

RESULTS

In total, 1627 patients with HFmrEF were included with a median QRS duration of 90 ms (i.e., QRS duration ≥ 120 ms: 15%). Although the risk of long-term all-cause mortality was not affected by a prolonged QRS duration (35.1% vs. 28.7%; p = 0.057; HR = 1.254; 95% CI 0.993-1.583), patients with QRS duration ≥ 120 ms had a higher risk of HF-related rehospitalization (18.2% vs. 11.9%; p = 0.008; HR = 1.574; 95% CI 1.124-2.204). A QRS duration ≥ 120 ms was associated with long-term HF-related rehospitalization even after multivariable adjustment (HR 1.420, 95% CI 1.008-2.002, p = 0.045). Finally, the risks of long-term all-cause mortality and HF-related rehospitalization did not differ among patients with LBBB and RBBB.

CONCLUSION

A prolonged native QRS duration is independently associated with a higher risk of HF-related rehospitalization in HFmrEF, but not long-term all-cause mortality.

Where's the Remote? Failure to Report Clinical Workflows in Heart Failure Remote Monitoring Studies

BACKGROUND

Remote patient monitoring (RPM) clinical trials have reported mixed results in improving outcomes for patients with chronic heart failure (HF). The impact of clinical workflows that could impact RPM effectiveness is often overlooked. We sought to characterize workflows and response protocols that could impact outcomes in studies of noninvasive RPM in HF.

METHODS

We reviewed studies (1999-2024) assessing noninvasive RPM interventions for adults with HF. We collected 24 aspects of workflows describing education, physiologic and symptomatic data collection, transmission and review, clinical escalation protocols, and response time. We attempted to perform a meta-analysis to identify associations between workflow components and outcomes of death and hospitalization.

RESULTS

We identified 63 studies (57.1% randomized controlled, 23.8% pilot/feasibility, 19.1% other) comprising 16,699 subjects. Despite a large number of studies and subjects, workflow reporting was insufficient to perform our intended meta-analysis regarding key workflow components. RPM clinical workflows were diverse in configuration, with high variability in component description ranging from always reported to never reported. Specifics of monitoring devices and related training were well reported as expected based on most trial hypotheses. However, elements of clinical data response such as frequency of data review, clinical escalation criteria, and provider response time were often underreported or not reported at all (48%, 24%, and 97%, respectively), hindering study replication and evidence-based implementation.

CONCLUSIONS

Clinical workflows are poorly described in noninvasive RPM studies, preventing systematic assessment, device comparison, and replication. A standardized approach to reporting HF RPM workflows is vital to evaluate effectiveness and guide evidence-based clinical implementation.