Adequate contacts after remote monitoring alerts were associated with improved outcomes in chronic heart failure: results from the OptiLink HF study

Abstract

Aims To investigate the effects of adequate reactions to telemedicine alerts triggered by fluid index threshold crossings (FTC) on clinical outcomes in the OptiLink HF trial. Methods We separated adequate from inadequate reactions to FTC transmissions in patients with remote impedance-based monitoring (RM) of fluid status in the OptiLink HF trial. Adequate contacts had to meet the following criteria: i) initial telephone contact within 2 working days after FTC transmission, ii) follow-up contacts according to study protocol, and iii) medical intervention initiated after FTC due to true fluid overload. We compared time to cardiovascular (CV) death or heart failure (HF) hospitalization and all CV- and HF-hospitalizations at follow-up between RM patients contacted adequately or inadequately and patients with usual care (UC). Results In the RM group, transmission of at least one FTC alert occurred in 356 patients (70.5%; n=505). While 113 patients (31.7%; n=356) have been contacted adequately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an adequate contact. Adequate responses to RM significantly reduced risk of the primary endpoint (hazard ratio (HR), 0.68; 95% confidence interval (CI) 0.48–0.95; p=0.025, figure 1), and led to a significantly lower number of CV (52.1±7.5 vs. 99.9±19.8; p=0.007) and HF hospitalizations per 100 patient years when compared with UC (26.1±4.4 vs. 67±15.2; p=0.007). Conclusion RM with adequate reactions to FTC alerts significantly reduced total number of both CV and HF hospitalizations and improved clinical outcomes in patients with advanced HF and implantable cardioverter defibrillator (ICD). Funding Acknowledgement Type of funding source: None

Challenges in the remote monitoring of cardiac implantable electronic devices in 2021

“…In a recently published analysis of the results of the Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™ (OptiLink HF) study, for example, RM appropriate reactions to intrathoracic fluid index threshold crossings alerts were associated with significantly improved clinical outcomes in patients with advanced HF. Of note, in this study, only 55.5%of all transmitted FTCs were followed by an appropriate contact [9]. In the Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME) trial, additional follow-up visits to a specialized center for device follow-up in response to telemonitoring data were scheduled for 19% of patients in the RM group, with atrial tachyarrhythmia being the medical telemonitoring observation that most often led to patient contact [76].…”

“…Early recognition of true atrial high rate episodes (AHREs) in patients with undiagnosed subclinical atrial fibrillation (AF), especially among high risk patients [5], is another seminal contribution of remote monitoring to prevent detrimental complications such as ischemic stroke or systemic embolism [5][6][7][8], and device related issue such as low pacing percentage of cardiac resynchronization therapy (CRT). Moreover, daily assessment of efficacy of intervention allow to provide indication for device reprogramming, pharmacotherapy modification, or invasive procedures such as atrioventricular nodal ablation, VT or AF ablation [9]. Given the expansion of remote monitoring in real world and the growing interest of published evidence, we aim to summarize, in this brief review, main residual challenges and gaps of knowledge in the field.…”

Decongestive treatment adjustments in heart failure patients remotely monitored with a multiparametric implantable defibrillators algorithm

“…This would probably prevent the failure in reducing clinical events that has been previously reported when telemedicine alerts were not handled appropriately. Indeed, in the Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™ (OptiLink HF trial), impedance‐based remote monitoring failed to reduce clinical events, 23 the failure being ascribed to the low rate of alert‐driven interventions. Another reason could be the low sensitivity of impedance‐based HF alerts 24 that may have resulted in not treating potentially actionable events, or the high rate of false‐positive detections and a consequent increase in hospital admissions 25 .…”

The first survey on patient needs for remote monitoring of cardiac implantable electronic device in South Korea

“…[2] Timely management of unexpected cardiac events or CIED-related events can be achieved by home monitoring of CIEDs. [3,4,18,20,21] To achieve optimal RM, there is a prerequisite: dedicated, well-experienced personnel, facilities, and adequate education for medical experts/caregivers/ patients are required. Despite these prerequisites, RM of CIEDs reduced medical costs via lower required manpower in experienced centers [22,23] and this seems a reasonable medical option, especially given the present COVID-19 pandemic situation.…”

“…Telehealth is also widely used for monitoring various cardiac diseases [13–16] and, regarding patients with CIED, has been used for remote monitoring [17] . The extent of RM of CIEDs goes beyond monitoring the device parameters and providing information on patients’ condition [18–20] . RM in CIEDs utilizes unidirectional communication from the CIED recipients to their physicians, and the CIEDs can be monitored on a daily basis.…”