Remote Cardiac Monitoring in Patients With Heart Failure

Abstract

IMPORTANCE Heart failure (HF) is often characterized by an insidious disease course leading to frequent rehospitalizations and a high use of ambulatory care. Remote cardiac monitoring is a promising approach to detect worsening HF early and intervene prior to an overt decompensation.OBSERVATIONS Recently, a multitude of novel technologies for remote cardiac monitoring (RCM) in patients with HF have been developed and are undergoing clinical trials. This development has been accelerated by the COVID-19 pandemic.CONCLUSIONS AND RELEVANCE This review summarizes the major clinical trials on RCM in patients with HF and present the most recent developments in noninvasive and invasive RCM technologies.

Clinical trials: conventional or pragmatic?

“…The visits, if there will be one, will be conducted remotely. The collection of physical data will be by appropriate telemetric methods, which is expected to rapidly increase 10 . Of course, in remote trials the EHR system is vital for capturing clinical events (endpoints) and understand the disease evolution.…”

“…The collection of physical data will be by appropriate telemetric methods, which is expected to rapidly increase. 10 Of course, in remote trials the EHR system is vital for capturing clinical events (endpoints) and understand the disease evolution. Information taken remotely reduces time, effort, and participants' travelling expenses.…”

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

“…Remote cardiac monitoring (RCM) has great promise in the care of patients with heart failure by alerting clinicians to clinical and subclinical changes and allowing them to intervene prior to overt decompensation. A recent comprehensive review of RCM divided these technologies into: wearable devices, cardiovascular implantable electronic device (CIED)-based technologies, and invasive pressure monitoring [5]. These technologies offer the prospect of remotely assessing patient symptoms, volume status, and activity, thereby addressing a significant barrier to effective heart failure management and medication titration [5].…”

“…Overall, although a great variety of technologies are in development, the ideal monitoring strategies and treatment approaches are, in many cases, unknown given that seminal CardioMEMs studies did have protocolized interventions for changes in PA pressures [5]. Understanding how to combine pressure monitoring, connectivity to EHR, and appropriate clinical response (i.e.…”

“…Heart failure quality improvement efforts are common but large-scale efforts to improve heart failure therapy and outcomes, specifically, have had varying degrees of success [5]. In this review, we hope to highlight lessons learned from prior large-scale heart failure quality initiatives and electronic health record (EHR)-embedded clinical alert studies, review the use of nontraditional visits (e.g.…”