Clinical and economic impact of HeartLogic™ compared with standard care in heart failure patients

Abstract

Aims The implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator-based HeartLogic ™ algorithm has recently been developed for early detection of impending decompensation in heart failure (HF) patients; but whether this novel algorithm can reduce HF hospitalizations has not been evaluated. We investigated if activation of the HeartLogic algorithm reduces the number of hospital admissions for decompensated HF in a 1 year post-activation period as compared with a 1 year pre-activation period. Methods and results Heart failure patients with an implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator with the ability to activate HeartLogic and willingness to have remote device monitoring were included in this multicentre non-blinded single-arm trial with historical comparison. After a HeartLogic alert, the presence of HF symptoms and signs was evaluated. If there were two or more symptoms and signs apart from the HeartLogic alert, lifestyle advices were given and/or medication was adjusted. After activation of the algorithm, patients were followed for 1 year. HF events occurring in the 1 year prior to activation and in the 1 year after activation were compared. Of the 74 eligible patients (67.2 ± 10.3 years, 84% male), 68 patients completed the 1 year follow-up period. The total number of HF hospitalizations reduced from 27 in the pre-activation period to 7 in the post-activation period (P = 0.003). The number of patients hospitalized for HF declined from 21 to 7 (P = 0.005), and the hospitalization length of stay diminished from average 16 to 7 days (P = 0.079). Subgroup analysis showed similar results (P = 0.888) for patients receiving cardiac resynchronization therapy during the pre-activation period or not receiving cardiac resynchronization therapy, meaning that the effect of hospitalizations cannot solely be attributed to reverse remodelling. Subanalysis of a single-centre Belgian subpopulation showed important reductions in overall health economic costs (P = 0.025). Conclusion Activation of the HeartLogic algorithm enables remote monitoring of HF patients, coincides with a significant reduction in hospitalizations for decompensated HF, and results in health economic benefits.

Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic

“…In previous works, the ability of HeartLogic to detect actionable HF events has been demonstrated, facilitating effective remote management [ 25 , 26 , 27 , 28 , 29 ]. In the context of the COVID-19 pandemic, the multisensor diagnostic platform was used effectively to facilitate the remote assessment of patient conditions.…”

Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America

“…117 Particular algorithms can, for example, integrate a multivariate index of heart sounds, respiration rate, thoracic impedance, and physical activity to attempt to predict the degree of congestion, with early evidence of association with fewer HF hospitalizations. 118 However, the utility of this technology in differentiating HF from COVID-19related lung injury yielded mixed results. 119,120 The post-pandemic world of remote monitoring and telemedicine for patients with HF is likely to include all forms of care including virtual, in-person, and remote assessments.…”

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

“…Recent data have also suggested that activation of the multi-sensor algorithm might result in a significant reduction in hospitalizations for decompensated HF. 15 Recently, Calò et al 9 analyzed the alert management strategies adopted at 22 centers and found that, when clinical actions were undertaken in response to alerts, the rate of HF events was lower. In their experience, actions consisted mainly of drug adjustments.…”