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Published on: July 18, 2014
Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization
Giovanni B Perego1, Maurizio Landolina, Giuseppe Vergara
1Istituto Auxologico S. Luca, Milan, Italy. perego@auxologico.it
Insights
Device-detected intrathoracic impedance changes and low patient activity predict heart failure (HF) hospitalization. These findings aid in prognostic stratification for HF patients receiving resynchronization therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Heart failure (HF) management relies on accurate risk stratification.
- Device-derived data offers potential for continuous patient monitoring.
Purpose of the Study:
- To investigate the association between device-determined indices, including intrathoracic impedance, and HF hospitalization.
- To evaluate the prognostic value of specific device metrics in HF patients.
Main Methods:
- Prospective data collection from 558 HF patients undergoing CRT-D therapy.
- Analysis of intrathoracic impedance fluid index threshold crossing events (TCE), activity, heart rate variability (HRV), and night heart rate (NHR).
Main Results:
- Patients hospitalized for HF showed higher rates of TCE, low activity, low HRV, and high NHR.
- TCE was independently associated with a 36% increased probability of HF hospitalization.
- TCE duration and patient activity also significantly correlated with hospitalization risk.
Conclusions:
- Decreased intrathoracic impedance, low activity, and low HRV are independent predictors of HF hospitalization.
- Device-derived data, such as TCE, can reliably stratify risk in HF patients.
- These metrics enhance prognostic assessment for patients on resynchronization therapy.
Purpose:
To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization.
Methods:
Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers. Device-recorded intrathoracic impedance fluid index threshold crossing event (TCE), mean activity counts, tachyarrhythmia events, night heart rate (NHR) and heart rate variability (HRV) were compared within patients with vs. without documented HF hospitalization.
Results:
Mean follow-up was 326 +/- 216 days. Patients hospitalized for HF had significantly higher rates of TCE, a higher percentage of days with the thoracic impedance fluid index above the programmed threshold, a higher percentage of days with low activity, with low HRV or with high NHR. Multivariate analysis showed that TCE resulted in a 36% increased probability of HF hospitalization. Both TCE duration and patient activity were also significantly associated with hospitalization. Kaplan Meier analysis indicated that patients with more TCE events were significantly more likely to be hospitalized (log rank test, p = 0.005).
Conclusions:
Decreased intrathoracic impedance, low patient activity and low HRV were all independently associated with increased risk for HF hospitalization in HF patients treated with resynchronization therapy. Device-derived diagnostic data may provide valuable and reliable indices for the prognostic stratification of HF patients.
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