How can clinicians remotely interpret device parameters in heart failure patients?
By Prof. Gianfranco Sinagra, Professor of Cardiology at University of Trieste, Italy
Due to the high rates of mortality and morbidity in heart failure patients, it is essential that heart failure cases are continuously and proactively monitored.
Remote monitoring can help address this need, as it has been shown to effectively provide physicians with the data needed to make crucial decisions as part of heart failure management. The widely cited IN-TIME study1 showed a decrease in decompensation events for heart failure patients proactively monitored by the remote monitoring system. It also showed significant reduction of all-cause mortality in heart failure patients of more than 60 percent, and a beneficial impact on the composite clinical score with implant-based (ICD or CRT-D) remote monitoring, when compared to standard care.
Why are the diagnostic parameters important for physicians?
The remote monitoring diagnostic parameters can be used as a valuable means of gathering information.
- You can evaluate technical parameters on the device (threshold, sensing, impedances, battery status etc).
- You can monitor the patient’s clinical status. Depending on the implanted device, the combination of available parameters (heart rate, heart rate variability, thoracic impedance, supraventricular tachyarrhythmia episodes, physical activity, etc) provides a huge opportunity to flag the condition of the patient so you can take action.
Regardless of the existence of prognostic scores generated by these parameters, the individual results make it possible to be alerted if there has been a change in the patient’s clinical status. Results like if the patient moves less and has an accelerated heart rate, if there is an onset of a supraventricular tachyarrhythmia, or if the parameters of thoracic impedance or heart rate variability have changed, can constitute at least a warning. They can often also provide valuable data that can be used when assessing whether to contact a patient and determine whether you need to see them for further follow-up. And of course, if you are convinced after having evaluated the patient that they need to be hospitalized, you are able to help mentally prepare them for that possibility ahead of time.
These advantages are in addition to the benefits remote patient monitoring can already provide to a range of cardiac patients, through the reduction of face-to-face visits.
For more advice on how to transition cardiac device practices to remote monitoring, read what Matthew Swift had to say. He’s a Lead Cardiac Physiologist at Great Western Hospital in the UK.