Telemedicine in heart failure—more than nice to have?

Fig. 1. CardioMEMS, implantable haemodynamic monitoring system. a CardioMEMS sensor or transmitter. b Transcatheter is implanted into a distal branch of the descending pulmonary artery. c The patient is instructed to take daily pressure readings from home using the home electronics. d Information transmitted from the monitoring system to the database is immediately available to the investigators for review. e Transmitted information consists of pressure trend information and individual pulmonary artery pressure waveforms. With permission from Elsevier, original figure from Abraham et al. Lancet. 2011;377:658–66

Fig. 2. Examples of invasive monitoring. a OptiVOL of Medtronic pacemaker/ICD devices. b Results presented for OptiVol with the thoracic impedance (ohms) measured and the OptiVol fluid index, resulting from the difference of measured thoracic impedance and reference thoracic impedance, with threshold. As the patient’s lungs become congested, intrathoracic impedance tends to decrease. Similarly, an increase in intrathoracic impedance may indicate the patient’s lungs are becoming more dry. c The Chronicle® Implantable Hemodynamic Monitor. d Results of Right Ventricle (RV) Systolic Pressure measurements of a sensor on a transvenous lead positioned in the right ventricle and estimated pulmonary artery diastolic (ePAD) pressures. With permission, original figure A/B/C from source: Medtronic Inc. With permission from Elsevier, original figure D from Bourge et al. Am Coll Cardiol. 2008;51:1073–9

Fig. 3. Telemonitoring system for remote monitoring of arrhythmia and heart failure patients. Multi-parameter data acquisition and transmission should be fully automatic with smooth data flow to medical staff/arrhythmia and heart failure monitoring centre. Optimised data workflow: normal data are automatically stored in a patient’s electronic file without further detailed evaluation. Alarm threshold crossing triggers detailed data review and potential medical action. With permission from Oxford University Press, original figure from Varma N, Ricci RP. Eur Heart J. 2013;34:1885–95 and reprinted/adapted figure in Hindricks G, Varma N. Eur Heart J. 2016;37:3164–6