Daily ambulatory remote monitoring system for drug escalation in chronic heart failure with reduced ejection fraction: pilot phase of DAVID-HF study

Figures

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  Figure 1. The home-based remote heart failure management system. (A) Wearable armband monitor, Everion (Biofourmis), capable of tracking heart rate, heart rate variability, blood pulse wave, oxygen saturation, respiration rate, skin temperature, electrodermal activity, and steps count. The wearable monitor was worn during daytime and recharged while bathing or sleeping. (B) Screenshots of patient smartphone application, and (C) clinician dashboard.

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  Figure 2. Utilization of guideline-directed heart failure medications. (A) Proportion of patients on heart failure medications, (B) proportion of patients on ≥50% maximal target dose of heart failure medications, and (C) mean percentage heart failure medications, at baseline and the end of the study period. *P < 0.05. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor and neprilysin inhibitor; HF, heart failure; MRA, mineralocorticoid receptor antagonist; MTD, maximal target dose; SGLT, sodium glucose cotransporter.

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  Figure 3. Change in the mean percentage maximal target dose of heart failure medications over the study period. (A) Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor and neprilysin inhibitor, angiotensin receptor and neprilysin inhibitor, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, (B) beta-adrenergic blocker and ivabradine, and (C) mineralocorticoid receptor antagonist and sodium glucose cotransporter inhibitor. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor and neprilysin inhibitor; HF, heart failure; MRA, mineralocorticoid receptor antagonist; MTD, maximal target dose; SGLT, sodium glucose cotransporter.

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  Figure 4. (A) New York Heart Association Function class at baseline and the end of study, and (B) percentage change in serum NT-proBNP concentration and increase in the percentage MTD of HF medications of individual patients from baseline to the end of study. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor and neprilysin inhibitor; HF, heart failure; MRA, mineralocorticoid receptor antagonist; MTD, maximal target dose; SGLT, sodium glucose cotransporter.

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  Figure 5. (A) The maximum number of steps taken within 6 min periods were used as proxies for 6 min walk test. There was no statistically significant difference in 6 min walk test in the first week of study (P = 0.1). (B) When stratified by change in % total maximal target dose, patients with at least 50% increase in % total maximal target dose showed significantly larger improvements in 6 min walk test in the last week of study when comparing with the first week of study (P = 0.009*). (C) Overall patients’ daily mean Biovitals Index was significantly lower in the last week of study when compared with the first week of study (P = 0.02*), indicating more stable physiological parameters and fewer symptoms. MTD, maximal target dose.