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Associations of Home Monitoring Data to Interventional Catheterization for Infants with Recurrent Coarctation of the
Parth S Patel1, Shil K Shah1, Keith Feldman2
1University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Insights
Caregiver-submitted home monitoring data, including increased weight and video recordings, can help identify infants with hypoplastic left heart syndrome at risk for recurrent coarctation of the aorta (RCoA). This aids earlier detection and intervention for this high-risk complication.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Management
- Remote Patient Monitoring
Background:
- The interstage period after the Norwood procedure for hypoplastic left heart syndrome (HLHS) poses significant risks, with 10-20% of infants developing recurrent coarctation of the aorta (RCoA).
- Mobile applications are increasingly used in interstage programs to collect physiologic data and videos from caregivers, facilitating remote patient monitoring.
Purpose of the Study:
- To determine if caregiver-entered home monitoring data can lead to earlier identification of infants requiring interventional catheterization for RCoA.
- To analyze associations between specific caregiver-recorded data points and the incidence of RCoA in HLHS infants during the interstage period.
Main Methods:
- A retrospective analysis of home monitoring data was conducted from five high-volume Children's High Acuity Monitoring Program®-affiliated centers between 2014 and 2021.
- Data included infant demographics, weight, heart rate (HR), oxygen saturation (SpO2), video recordings, and caregiver-reported 'red flag' concerns prior to interstage readmissions.
- Statistical analysis identified associations between recorded data and the need for RCoA intervention.
Main Results:
- 27% (44/161) of infants required interventional catheterization for RCoA.
- In the 7 days preceding readmission, increased RCoA odds were associated with a higher number of recorded videos and weight entries, and more days of data recording.
- Increasing mean SpO2 and greater variation/range in HR were also linked to higher odds of RCoA.
Conclusions:
- Infants with RCoA exhibited increased caregiver-entered home monitoring data, including weight and video recordings, alongside notable changes in HR and SpO2 trends.
- Early identification of these specific home monitoring data patterns by clinical teams may significantly improve the evaluation and management of RCoA in this vulnerable pediatric population.
Abstract:
The post-Norwood interstage period for infants with hypoplastic left heart syndrome is a high-risk time with 10-20% of infants having a complication of recurrent coarctation of the aorta (RCoA). Many interstage programs utilize mobile applications allowing caregivers to submit home physiologic data and videos to the clinical team. This study aimed to investigate if caregiver-entered data resulted in earlier identification of patients requiring interventional catheterization for RCoA. Retrospective home monitoring data were extracted from five high-volume Children's High Acuity Monitoring Program®-affiliated centers (defined as contributing > 20 patients to the registry) between 2014 and 2021 after IRB approval. Demographics and caregiver-recorded data evaluated include weight, heart rate (HR), oxygen saturation (SpO2), video recordings, and 'red flag' concerns prior to interstage readmissions. 27% (44/161) of infants required interventional catheterization for RCoA. In the 7 days prior to readmission, associations with higher odds of RCoA included (mean bootstrap coefficient, [90% CI]) increased number of total recorded videos (1.65, [1.07-2.62]) and days of recorded video (1.62, [1.03-2.59]); increased number of total recorded weights (1.66, [1.09-2.70]) and days of weights (1.56, [1.02-2.44]); increasing mean SpO2 (1.55, [1.02-2.44]); and increased variation and range of HR (1.59, [1.04-2.51]) and (1.71, [1.10-2.80]), respectively. Interstage patients with RCoA had increased caregiver-entered home monitoring data including weight and video recordings, as well as changes in HR and SpO2trends. Identifying these items by home monitoring teams may be beneficial in clinical decision-making for evaluation of RCoA in this high-risk population.
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