Key result
Remote monitoring with appropriate fluid alert contacts linked to ~39% fewer CV deaths or HF hospitalizations.
Why the study?
Impedance-based remote monitoring failed to reduce clinical events in OptiLink HF, but rates of alert-driven interventions were low, indicating inappropriate physician reactions to alerts.
Does impedance-based remote monitoring with appropriate contacts to alerts reduce cardiovascular death or HF hospitalization in patients with advanced HF and implantable cardioverter-defibrillators?
Observational
Does impedance-based remote monitoring with appropriate contacts to alerts reduce cardiovascular death or HF hospitalization in patients with advanced HF and implantable cardioverter-defibrillators?
Hazard Ratio: 0.61 (95% CI 0.39–0.95)
p-value: p=0.027
Appropriate clinical reactions to remote monitoring alerts for fluid accumulation are associated with improved clinical outcomes in advanced heart failure patients.
Appropriate responses to fluid alerts were associated with lower CV death or HF hospitalization risk; leaves open whether RCTs will confirm benefit in advanced HF.
Background: Impedance-based remote monitoring (RM) failed to reduce clinical events in the OptiLink heart failure (HF) trial. However, rates of alert-driven interventions triggered by intrathoracic fluid index threshold crossings (FTC) were low indicating physicians’ inappropriate reactions to alerts. Methods: We separated appropriate from inappropriate contacts to FTC transmissions in the OptiLink HF trial (Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™). Appropriate contacts had to meet the following criteria: (1) initial telephone contact within 2 working days after FTC transmission, (2) follow-up contacts according to study protocol, and (3) medical intervention initiated after FTC due to cardiac decompensation. We compared time to cardiovascular death or HF hospitalization between RM patients contacted appropriately or inappropriately and patients with usual care. Results: In the RM group, at least one FTC alert was transmitted in 356 patients (70.5%; n=505). Of note, only 55.5% (n=758) of all transmitted FTCs (n=1365) were followed by an appropriate contact. While 113 patients (31.7%; n=356) have been contacted appropriately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an appropriate contact. Compared with usual care, RM with appropriate contacts to FTC alerts independently reduced the risk of the primary end point (hazard ratio, 0.61 [95% CI, 0.39–0.95]; P =0.027). Conclusions: RM appropriate reactions to FTC alerts are associated with significantly improved clinical outcomes in patients with advanced HF and implantable cardioverter-defibrillators.
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Wintrich et al. (2020) conducted an observational in Chronic Heart Failure. Remote monitoring with appropriate contacts to FTC alerts vs. Usual care was evaluated on Time to cardiovascular death or HF hospitalization (HR 0.61, 95% CI 0.39-0.95, p=0.027). Remote monitoring with appropriate contacts to fluid index alerts reduced the risk of cardiovascular death or heart failure hospitalization compared with usual care (HR 0.61; 95% CI 0.39-0.95; P=0.027).
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