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Differentiating sensor changes in a composite heart failure ICD monitoring index: Clinical correlates and

Paolo Compagnucci1, Vincenzo Ezio Santobuono2, Antonio D'Onofrio3

  • 1Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy.

Heart Rhythm
|October 20, 2024
PubMed

Insights

HeartLogic alerts predicting heart failure (HF) decompensation are primarily driven by heart sounds, but clinical events correlate more with respiration rate and night heart rate. Sensor changes vary with recurrent alerts, suggesting diverse HF progression mechanisms.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • The HeartLogic algorithm utilizes implantable cardioverter-defibrillator (ICD) sensors to predict heart failure (HF) decompensation.
  • Sensors include heart sounds (S1, S3), intrathoracic impedance, respiration rate, ratio of respiration rate to tidal volume (RSBI), and night heart rate.

Purpose of the Study:

  • To assess relative changes in ICD sensors at HeartLogic alert onset.
  • To determine associations between alerts, patient characteristics, and outcomes.
  • To investigate sensor variability in recurrent alerts.

Main Methods:

  • Analysis of 1200 HeartLogic alerts in 370 patients with HF and ICDs (n=568) across 26 centers.
  • Median follow-up of 26 months, with alerts triggering patient contact and treatment.
  • Correlation of sensor changes with patient characteristics (AF, CKD) and clinical outcomes (HF hospitalization, death).

Main Results:

  • Heart sounds (S3, S3/S1) were the most frequent triggers for alerts (27%, 25%).
  • Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) showed higher alert prevalence and rates.
  • Clinical events (HF hospitalization/death) were associated with respiration rate/RSBI and night heart rate changes.
  • Sensor changes varied in recurrent alerts (85%), and first alerts were more linked to clinical events (12.6%).

Conclusions:

  • HeartLogic alerts are predominantly triggered by heart sound changes.
  • Respiration rate, RSBI, and night heart rate are more indicative of clinical events.
  • Variability in sensors for recurrent alerts highlights diverse HF progression pathways.
Abstract

Keywords:
CRTHeart failureICDRemote monitoringRisk stratification

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