Key result
High baseline HeartInsight score linked to ~105% greater risk of death or worsening heart failure.
Why the study?
The authors sought to assess whether a baseline multiparametric HeartInsight HF Score, determined at algorithm activation via remotely monitored ICDs, is associated with long-term patient outcomes.
Does a high baseline multiparametric heart failure score derived from remote ICD monitoring predict death or worsening heart failure hospitalization in patients with HFrEF and an ICD?
Meta-Analysis (n=1,841)
Yes
Does a high baseline multiparametric heart failure score derived from remote ICD monitoring predict death or worsening heart failure hospitalization in patients with HFrEF and an ICD?
Answers are grounded in this paper and cite their sources.
A baseline multiparametric heart failure score derived from remote ICD monitoring can effectively stratify patients at high risk for long-term death or worsening heart failure hospitalizations.
BACKGROUND: To predict worsening heart failure hospitalizations (WHFHs), the HeartInsight multiparametric algorithm calculates a heart failure (HF) Score based on temporal trends of physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators (ICDs). OBJECTIVE: We studied the association of the baseline HF Score, determined at algorithm activation, with long-term patient outcomes. METHODS: Data from 9 clinical trials were pooled, including 1841 ICD patients with a preimplantation ejection fraction ≤35%, New York Heart Association class II/III, and no long-standing atrial fibrillation. The primary end point was a composite of death or WHFH. RESULTS: After a median follow-up of 631 days (interquartile range, 385-865 days), there were 243 WHFHs in 173 patients (9.4%) and 122 deaths (6.6%), 52 of which (42.6%) were cardiovascular. The primary end point occurred in 265 patients (14.4%). A multivariable time-to-first-event analysis showed that a high baseline HF Score (>23, as determined by a time-dependent receiver operating characteristics curve analysis) was significantly associated with the occurrence of the primary end point (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.54-2.71; P < .0001), all-cause death (HR, 2.37; CI, 1.56-3.58; P < .0001), cardiovascular death (HR, 2.19; CI, 1.14-4.22; P = .019), and WHFH (HR, 1.91; CI, 1.35-2.71; P = .0003). In a hierarchical event analysis of all-cause death as the outcome with highest priority and WHFHs as repeated event outcomes, the win ratio was 2.47 (CI, 1.89-3.24; P < .0001). CONCLUSION: Based on a retrospective analysis of clinical trial data with adjudicated events, baseline HF Score derived from device-monitored variables was able to stratify patients at higher long-term risk of death or WHFH.
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D’Onofrio et al. (2024) conducted a meta-analysis in Heart failure in patients with implantable cardioverter-defibrillators (n=1,841). High baseline HeartInsight HF Score (>23) vs. Low baseline HF Score was evaluated on Composite of death or worsening heart failure hospitalizations (WHFH) (adjusted HR 2.05, 95% CI 1.54-2.71, p=< .0001). A high baseline HeartInsight heart failure score (>23) was associated with increased risk of death or worsening heart failure hospitalization.
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