Impact of five-sensor Multiparametric HF Index in defibrillators care: real-world clinical and economic evaluation

Introduction Heart failure (HF) is a leading cause of hospital admission; readmissions worsen prognosis and strain resources. A five-sensor multiparametric HF index embedded in implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices integrates intrathoracic impedance, S1/S3 heart sounds, respiratory rate, night heart rate, and physical activity to produce a daily decompensation-risk signal. Purpose To evaluate the clinical and economic impact of index-guided monitoring within a nurse-led hybrid follow-up pathway in routine care. Methods Single-centre retrospective cohort at our Hospital including consecutive ICD/CRT-D recipients between 01/2017 and 12/2021, with follow-up up to 48 months. Comparative cohort: HF index group (n=20) vs contemporary control (n=62). Primary endpoint: HF hospitalization (International Classification of Diseases, 10th Revision; ICD-10; length of stay >24 h) normalized per patient-year. Outcomes were analysed with generalized estimating equations (GEE) using Poisson/quasi-Poisson log-link, log(patient-years) offset, and adjustment for New York Heart Association (NYHA) class, atrial fibrillation (AF), age, and sex. The economic evaluation used a hospital perspective (direct inpatient and follow-up costs). Uncertainty was quantified with a non-parametric bootstrap (5,000 resamples), and cost-effectiveness was summarised with cost-effectiveness acceptability curves (CEACs) built by Monte Carlo simulation (10,000 iterations) of net monetary benefit. Results mean age 65.9±10.2 years; 28% women; NYHA I/II/III 6.1/82.9/11.0% (index 15/60/25%; control 3.2/90.3/6.5%); AF 10% (index) vs 25.8% (control); ≈95% CRT-D in both groups. Across 0–48 months (index 79.95 and control 247.83 patient-years), the HF hospitalization rate was markedly lower with the HF index group (adjusted incidence-rate ratio 0.147; 95% CI 0.038–0.569; p=0.006), ≈85% fewer admissions. HF Index-guided care was associated with higher follow-up intensity (adjusted IRR 2.242; 95% CI 1.460–3.442; p=0.00022) but fewer inpatient days (≈0.8 fewer days per patient-year). Savings from reduced inpatient stay (−€669.9/patient-year) offset additional follow-up costs (+€428.7/patient-year), yielding net savings of −€241.2/patient-year. The CEAC indicated a 96.9% probability of cost-effectiveness at the hospital reference threshold (€847.96/day avoided). Conclusions Embedding a five-sensor multiparametric HF index in a structured, nurse-led hybrid pathway was associated with substantial reductions in HF admissions and bed-days and favourable hospital economics, shifting expenditure from acute inpatient care to planned follow-up.