Impact and Safety of Remote Monitoring of Heart Failure Patients Managed with the Heartlogic Algorithm – The Heartlogic France Cohort Study –

Background HeartLogic, an algorithm in implanted devices, predicts heart failure (HF) episodes via a remotely monitored index, aiding proactive congestion treatment to prevent acute decompensation. This study assessed the efficacy and safety of pre-emptive HF management using the HeartLogic index. Methods The HeartLogic France Cohort Study is a prospective multicentre investigation involving 310 HF patients with implanted cardioverter defibrillators enrolled from 10 French centres. The HeartLogic™ index was monitored for 12 months, and when the index reached ≥16, patients were contacted to adjust HF treatment. The primary endpoint was unscheduled hospitalization for HF. An independent blinded committee adjudicated the events. Results A total of 309 patients (65±10 years old; 83.5% male, left ventricular ejection fraction 31±9%) were included in the analysis. Ischemic cardiomyopathy was present in 61.2% (n=189) of the patients, and 52.8% (n=163) had a cardiac resynchronization therapy device. During follow-up, 406 alerts occurred in 158 patients (1.33 alerts/patient-year), resulting in treatment modification in 39.6% of alerts. A total of 24 unplanned HF hospitalizations occurred in 19 (6.1%) patients. Sixteen (66.7%) of those hospitalizations were preceded by a HeartLogic alert, of which 14 (87.5%) triggered a drug modification before hospitalization. Eighteen deaths (5.8%) occurred, including 10 due to cardiovascular causes. An increase in creatinine ≥30% and symptomatic hypotension were reported in two patients. Hyperkalemia and hyponatremia were not observed. Conclusion Pre-emptive HF management guided by the HeartLogic index was associated with low rates of unplanned hospitalizations and adverse events over a 12-month follow-up period. Study registration ClinicalTrials.gov, ID: NCT04619888.