Dynamic changes in nocturnal heart rate predict short-term cardiovascular events in patients using the wearable cardioverter-defibrillator: from the WEARIT-France cohort study

Abstract

Aims While elevated resting heart rate measured at a single point of time has been associated with cardiovascular outcomes, utility of continuous monitoring of nocturnal heart rate (NHR) has never been evaluated. We hypothesized that dynamic NHR changes may predict, at short term, impending cardiovascular events in patients equipped with a wearable cardioverter-defibrillator (WCD). Methods and results The WEARIT-France prospective cohort study enrolled heart failure patients with WCD between 2014 and 2018. Night-time was defined as midnight to 7 a.m. NHR initial trajectories were classified into four categories based on mean NHR in the first week (High/Low) and NHR evolution over the second week (Up/Down) of WCD use. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. A total of 1013 [61 (interquartile range, IQR 53–68) years, 16% women, left ventricular ejection fraction 26% (IQR 22–30)] were included. During a median WCD wear duration of 68 (IQR 44–90) days, 58 patients (6%) experienced 69 events. After considering potential confounders, High-Up NHR trajectory was significantly associated with the primary endpoint compared to Low-Down [adjusted hazard ratio (HR) 6.08, 95% confidence interval (CI) 2.56–14.45, P < 0.001]. Additionally, a rise of >5 bpm in weekly average NHR from the preceding week was associated with 2.5 higher composite event risk (HR 2.51, 95% CI 1.22–5.18, P = 0.012) as well as total mortality (HR 11.21, 95% CI 3.55–35.37, P < 0.001) and cardiovascular hospitalization (HR 2.70, 95% CI 1.51–4.82, P < 0.001). Conclusion Dynamic monitoring of NHR may allow timely identification of impending cardiovascular events, with the potential for ‘pre-emptive’ action. Registration number Clinical Trials.gov Identifier: NCT03319160

Declining Trend of Sudden Cardiac Death in Younger Individuals: A 20–Year Nationwide Study

“…Prevention of SCD that occur unwitnessed or during sleep is particularly difficult, as timely recognition and intervention is hindered and survival chances thus dramatically lower. However, connected devices —e.g., smart watches and speakers— are increasingly capable of identifying malignant arrhythmias and alerting first responders or family members 41,42 . Although these solutions are still in their infancy, they present an exciting opportunity to monitor high-risk patients and lower mortality 43,44 .…”

Pre‐emptive treatment of heart failure exacerbations in patients managed with the HeartLogic™ algorithm

“…The concept of Near‐Term Prevention, that emerged a few years ago, 20 is now becoming increasingly important in the field of sudden cardiac death management with the exponential use of connected devices collecting biometric data and the use of artificial intelligence. 21 , 22 The general functioning of HeartLogic™ remote monitoring is summarized in Figure 3 . Implementing pre‐emptive treatment of HF‐based short‐term prediction of events is not yet advocated in current international guidelines, even though it may significantly improve the prognosis of patients with HF and lead to high‐quality outpatient care ( Figure 4 ).…”