Risk stratification of cardiovascular and heart failure hospitalizations using integrated device diagnostics in
Haran Burri1, Antoine da Costa2, Aurelio Quesada3
1Department of Cardiology, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
Insights
The heart failure risk status (HFRS) algorithm in cardiac resynchronization therapy defibrillators (CRT-D) effectively identifies high-risk patients. This tool aids in managing remote monitoring alerts by focusing on patients with elevated heart failure risk.
Area of Science:
- Cardiology
- Biomedical Engineering
- Health Informatics
Background:
- Cardiac resynchronization therapy defibrillators (CRT-D) offer remote monitoring capabilities.
- An integrated algorithm can generate a heart failure risk status (HFRS) from monitored parameters.
- Effective risk stratification is crucial for managing heart failure (HF) patients.
Purpose of the Study:
- To validate the HFRS algorithm for patient risk stratification.
- To assess the association between HFRS and heart failure symptoms.
- To investigate the utility of HFRS in triaging automatic remote monitoring alerts.
Main Methods:
- Post hoc analysis of data from 722 patients in the MORE-CARE trial.
- Evaluation of the association between HFRS and subsequent cardiovascular hospitalizations.
- Correlation of HFRS with reported heart failure symptoms and remote monitoring alerts.
Main Results:
- A high HFRS significantly increased the risk of cardiovascular hospitalization (RR 4.5) and HF hospitalization (RR 6.3) within 30 days.
- The negative predictive value of low or medium HFRS for admissions was high (≥98%).
- High HFRS correlated with increased HF symptoms, and only 10% of remote alerts were associated with a high HFRS.
Conclusions:
- The HFRS algorithm effectively stratifies risk in CRT-D patients.
- HFRS can potentially improve the management of automatic remote monitoring alerts.
- Focusing on high-risk patients identified by HFRS allows for more efficient clinical attention.
Aims:
Cardiac resynchronization therapy defibrillators (CRT-D) are able to monitor various parameters that may be combined by an automatic algorithm to provide a heart failure risk status (HFRS). We sought to validate the HFRS for stratifying patient risk, evaluate its association with heart failure (HF) symptoms, and investigate its utility for triage of automatic alerts.
Methods And Results:
Data from 722 patients included in the MORE-CARE trial were analysed in a post hoc analysis. A high HFRS was associated with a significantly increased risk of admission over the next 30 days with a relative risk for cardiovascular hospitalization (CVH) of 4.5 (95% CI: 3.1-6.6, P < 0.001), of HF hospitalization of 6.3 (95% CI: 3.9-10.2, P < 0.001) and of non-HF related CVH of 3.5 (95% CI: 2.0-6.9, P < 0.001). The negative predictive value of low or medium HFRS for these admissions was ≥98%. A high HFRS was associated with an increased risk of HF symptoms. Of all the automatic remote monitoring alerts generated during the study, only 10% had a high HFRS.
Conclusion:
The HFRS is able to risk-stratify CRT-D patients, which is potentially useful for managing automatic remote monitoring alerts, by focusing attention on the minority of high-risk patients.
Clinical Trial Registration:
The trial was registered at www.clinicaltrials.gov under number NCT00885677.
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