Key result
Monthly remote monitoring of OptiVol fluid index levels combined with provider-guided screening and education was associated with a low 30-day CHF hospitalization rate of 2.2% following abnormal fluid levels.
Why the study?
The impact of a provider-driven assessment and treatment algorithm based on remote OptiVol fluid index levels on hospitalizations for congestive heart failure was unknown.
Does monthly remote monitoring of OptiVol fluid index levels with provider-guided screening reduce CHF hospitalizations in patients with CHF and LVEF ≤40% with an ICD?
Observational (n=279)
No
Does monthly remote monitoring of OptiVol fluid index levels with provider-guided screening reduce CHF hospitalizations in patients with CHF and LVEF ≤40% with an ICD?
A provider-guided screening and treatment algorithm based on remote OptiVol fluid index monitoring in HFrEF patients with ICDs is associated with a low rate of heart failure hospitalizations.
May inform remote OptiVol algorithms in HFrEF with ICDs; leaves open whether hospitalizations are reduced versus usual care.
The impact of a provider-driven assessment and treatment algorithm based on remote OptiVol (Medtronic, Minneapolis, MN, USA) fluid index levels on hospitalizations for congestive heart failure (CHF) remains unknown. We implemented a physician-guided screening and educational strategy for elevated OptiVol fluid index levels measured on remote implantable cardioverter-defibrillator (ICD) monitoring and assessed clinical outcomes over a five-year period. Patients with CHF and a left ventricular ejection fraction (LVEF) of 40% or less with a previously implanted ICD underwent monthly remote monitoring from January 2015 to November 2019. An OptiVol fluid index of 60 Ω-days or more triggered a protocol-based CHF screening and therapy adjustment according to clinical presentation. Among 279 patients included in the study, 228 (81%) were male and 205 (73%) had ischemic cardiomyopathy. The average LVEF was 29% (± 7.3%). A total of 6,616 monthly transmissions were reviewed over five years; of those, 575 (8.7%) were associated with elevated OptiVol fluid index levels in 178 (64%) patients, and clinical follow-up data were available in 459 of 575 (80%) cases. Following abnormal OptiVol fluid levels on remote monitoring, CHF hospitalization occurred in 10 of 459 (2.2%) patient cases. In conclusion, monthly remote monitoring of OptiVol fluid index levels with a health care provider-guided CHF screening and an educational approach to abnormal OptiVol fluid index levels were associated with a low CHF hospitalization rate. This compared favorably to prior similar studies, and randomized controlled prospective studies evaluating similar algorithms are warranted.
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Rosman et al. (2021) conducted an observational in Congestive heart failure (n=279). Monthly remote monitoring of OptiVol fluid index levels with provider-guided screening and education was evaluated on 30-day CHF hospitalization rate following an abnormal OptiVol fluid index level (≥ 60 Ω-days). Monthly remote monitoring of OptiVol fluid index levels combined with provider-guided screening and education was associated with a low 30-day CHF hospitalization rate of 2.2% following abnormal fluid levels.
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