Remote Monitoring With Appropriate Reaction to Alerts Was Associated With Improved Outcomes in Chronic Heart Failure

Abstract

Background: Impedance-based remote monitoring (RM) failed to reduce clinical events in the OptiLink heart failure (HF) trial. However, rates of alert-driven interventions triggered by intrathoracic fluid index threshold crossings (FTC) were low indicating physicians’ inappropriate reactions to alerts. Methods: We separated appropriate from inappropriate contacts to FTC transmissions in the OptiLink HF trial (Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™). Appropriate contacts had to meet the following criteria: (1) initial telephone contact within 2 working days after FTC transmission, (2) follow-up contacts according to study protocol, and (3) medical intervention initiated after FTC due to cardiac decompensation. We compared time to cardiovascular death or HF hospitalization between RM patients contacted appropriately or inappropriately and patients with usual care. Results: In the RM group, at least one FTC alert was transmitted in 356 patients (70.5%; n=505). Of note, only 55.5% (n=758) of all transmitted FTCs (n=1365) were followed by an appropriate contact. While 113 patients (31.7%; n=356) have been contacted appropriately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an appropriate contact. Compared with usual care, RM with appropriate contacts to FTC alerts independently reduced the risk of the primary end point (hazard ratio, 0.61 [95% CI, 0.39–0.95]; P =0.027). Conclusions: RM appropriate reactions to FTC alerts are associated with significantly improved clinical outcomes in patients with advanced HF and implantable cardioverter-defibrillators.

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.…”

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

“…[ 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. Although remote medical intervention (bidirectional communication) is impossible with CIED RM, experiences show enhanced patient satisfaction.…”

Chronic disease management in heart failure: focus on telemedicine and remote monitoring

“…In a recent post-hoc exploratory analysis, patients who had a fluid threshold crossing alert and had an appropriate medical contact had a 39% relative risk reduction of the primary endpoint. This study highlight the importance of linking telemonitoring with medical interventions [60]. CorVue TM algorithm (St. Jude Medical, St. Paul, MN, USA) detects the intrathoracic impedance providing 12 daily measurements and comparing to a reference.…”