目的:早期发现HF恶化可以及时调整以预防住院。最近的研究表明,HeartLogic™算法可检测拥塞并减少HF事件。然而,目前尚不清楚哪些患者获益最多。因此,本研究旨在识别和表征从基于HeartLogic™的基于CIED的远程监测中获益最大的HF患者。
方法:在这项多中心回顾性研究中,纳入了结构化随访下的aCIED和HeartLogic™算法患者.根据监测,患者被分类为具有“实质性益处”或“无益处”。
结果:总计,纳入242例患者(男性n=190,79%,中位年龄61岁[IQR61-77])。中位随访时间为1.2年[IQR1.1-2.7]。在378个警报中,真阳性266例(70%),假阳性112例(30%)。242名患者中,69人(29%)被归类为具有“实质性利益”,而173人(71%)从HeartLogic™监测中“没有获益”。单因素和多因素分析显示,“实质性获益”患者的NYHA功能分级较高(OR2.64,P=0.004),较高的NT-ProBNP(OR1.02,P=0.003),血清肌酐升高(OR1.10,P<0.001),较低的LVEF(OR1.19,P=0.004),二尖瓣反流更严重(OR2.16,P=0.006),右室舒张末期容积增高(OR1.05,P=0.040),肺动脉压较高(OR1.19,P=0.003),并且更可能使用loop利尿剂(OR2.79,P=0.001)。在有“实质性获益”的患者中,“HeartLogic™检测拥塞的阳性预测值(PPV)为92%。
结论:使用基于CIED的HeartLogic™驱动的HF治疗显示出明显的疗效,主要是在更晚期的疾病阶段表现出HF特征的患者。
OBJECTIVE: Early identification of worsening HF enables timely adjustments to prevent hospitalization. Recent studies show the HeartLogic™ algorithm detects congestion and reduces HF events. However, it is unclear which patients benefit most. Therefore, this study aims to identify and characterize HF patients who benefit most from
CIED-based remote monitoring with HeartLogic™.
METHODS: In this multicenter retrospective study, patients with a
CIED and HeartLogic™ algorithm under structured follow-up were included. Patients were classified as having \"substantial benefit\" or \"no benefit\" from monitoring.
RESULTS: In total, 242 patients were included (male n = 190, 79%, median age 61 years [IQR 61-77]). Median follow-up was 1.2 years [IQR 1.1-2.7]. Among 378 alerts, 266 were true positive (70%) and 112 false positive (30%). Of the 242 patients, 69 (29%) were classified as having \"substantial benefit\", while 173 (71%) had \"no benefit\" from HeartLogic™ monitoring. Univariate and multivariate analysis showed that patients with \"substantial benefit\" had higher NYHA functional class (OR 2.64, P = 0.004), higher NT-ProBNP (OR 1.02, P = 0.003), higher serum creatinine (OR 1.10, P < 0.001), lower LVEF (OR 1.19, P = 0.004), more severe mitral regurgitation (OR 2.16, P = 0.006), higher right ventricular end diastolic volume (OR 1.05, P = 0.040), higher pulmonary artery pressures (OR 1.19, P = 0.003), and were more likely to use loop diuretics (OR 2.79, P = 0.001). Among patients with \"substantial benefit,\" the positive predictive value (PPV) of HeartLogic™ to detect congestion was 92%.
CONCLUSIONS: The utilization of
CIED-based HeartLogic™ driven HF care demonstrated pronounced efficacy, predominantly in patients exhibiting characteristics of HF at a more advanced disease stage.