Optimising heart failure care; real world outcomes from algorithm-based remote monitoring and digital pathway transformation

Background Heart failure (HF) is a major challenge in healthcare, driving high morbidity and resource use. With increasing patient numbers and complexity, timely intervention and efficient care are critical. Remote monitoring via cardiac implantable electronic devices (CIEDs) with algorithm-based alerts enables clinicians to detect decompensation early and intervene proactively. National guidance now endorses this approach for CIED patients. Our centre monitors over 1,000 CIED patients and has integrated advanced digital solutions to improve efficiency. Purpose To assess the diagnostic accuracy and resource impact of CIED based HF alert management in a contemporary HF service and identify ways to improve the clinical pathway for these patients. Methods CIEDs have algorithm-based multisensory monitoring. Our HF service incorporated heart failure alerts from a single vendor’s CIED platform for patients on remote monitoring with standardised protocols for alert management and follow-up. A service evaluation was undertaken prospectively, focusing on HF hospitalisation and clinical outcomes. After establishing the clinical pathway, we implemented the vendor’s value-add digital workflow solution, which automated and streamlined alert management. The resource implications of this strategy were assessed. Results During the 12-month service evaluation, no HF hospitalisation occurred in the absence of a HF alert, resulting in a 100% sensitivity. The digital workflow platform improved workflow efficiency. 77% reduction in average time to manage a HF alert, and 22% reduction in time patients spent in alert state were observed. We also observed a 17% reduction in time to action first HF alert. A 7.5hours/week reduction in clinical workload was noted with improved efficiency and cost saving. Conclusion CIED alert-based HF care alongside digital workflow optimisation has transformed HF management at our centre, with improvements in both clinical outcomes and resource utilisation. The strong negative predictive value seen allows for confidence in alert-based follow-up of HF patients with CIEDs in situ. Our experience demonstrates that partnering with industry for digital transformation enables sustainable, patient-centric care.