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Temporal Characteristics of Device-Based Individual and Integrated Risk Metrics in Patients
Michael R Zile1, Rami Kahwash2, Shantanu Sarkar3
1Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.
Insights
Patients with heart failure (HF) and implantable devices show distinct risk score patterns. Those without HF readmission experienced a greater recovery of risk metrics post-event compared to those with readmission.
Area of Science:
- Cardiology
- Biomedical Engineering
- Health Informatics
Background:
- Temporal patterns of multimetric risk scores and individual parameters around heart failure (HF) events remain undefined.
- Understanding these dynamics is crucial for predicting HF recurrence and optimizing patient management.
Purpose of the Study:
- To define the temporal characteristics of a multimetric risk score and its components before, during, and after a heart failure event.
- To compare these characteristics between patients with and without HF readmissions.
Main Methods:
- Utilized a real-world cohort of 17,886 patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators.
- Linked deidentified health records with device manufacturer data.
- Defined HF events and analyzed a multimetric risk score incorporating daily measures of impedance, heart rate, activity, heart rate variability, atrial fibrillation burden, CRT pacing, and ventricular arrhythmias.
Main Results:
- Patients with HF readmission exhibited higher risk scores for 60 days before and after an HF event compared to those without readmission (P < 0.001).
- While the risk score change from admission to discharge was similar, patients without HF readmission showed a more significant decrease in risk score 7 and 30 days post-discharge (P < 0.001).
Conclusions:
- Significant differences exist in the temporal characteristics of risk metrics between patients with and without HF readmissions.
- Patients who did not experience HF recurrence demonstrated a more substantial recovery of risk metric values toward normal levels post-event.
Background:
Temporal characteristics of a multimetric risk score and its individual parameters before, during, and after a heart failure (HF) event have not been defined.
Objectives:
A large real-world patient cohort with implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) defibrillators was used to define these temporal characteristics.
Methods:
Deidentified health records were linked to manufacturer's device database in 17,886 patients. Multimetric risk score combined daily measures of impedance, heart rate, activity, heart rate variability, and atrial fibrillation (AF) burden, AF ventricular rate, CRT pacing, and ventricular tachycardia episodes and shocks. HF event was defined as an inpatient, emergency department, or observation unit stay with primary diagnosis of HF and intravenous diuretic agents administration. Changes in risk parameters during 60 days before, during, and after an HF event were compared in patients with no HF readmissions vs patients with HF readmission.
Results:
A total of 1,174 patients had HF events with no HF readmission, and 282 patients had HF events with HF readmission. Diagnostic risk score was higher on all 60 days before and after a HF event in patients with HF readmission compared with patients with no readmission (P < 0.001). Change in risk score from admission to discharge was similar in patients with and without HF readmission, but the risk score fell more significantly 7 after discharge and 30 days after admission in patients without HF readmission (P < 0.001).
Conclusions:
Temporal characteristics of risk metrics were significantly different in patients with no HF readmissions vs patients with HF readmission; patients without HF recurrence had larger recovery of risk metrics values toward normal.
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