Abstract
The wearable cardioverter–defibrillator (WCD) is used in patients with newly diagnosed heart failure and reduced ejection fraction (HFrEF). In addition to arrhythmic events, the WCD provides near-continuous telemetric heart failure monitoring. The purpose of this study was to evaluate the clinical relevance of additionally recorded parameters, such as heart rate or step count. We included patients with newly diagnosed HFrEF prescribed with a WCD. Via the WCD, step count and heart rate were acquired, and an approximate for heart rate variability (HRV5) was calculated. Multivariate analysis was performed to analyze predictors for an improvement in left ventricular ejection fraction (LVEF). Two hundred and seventy-six patients (31.9% female) were included. Mean LVEF was 25.3 ± 8.5%. Between the first and last seven days of usage, median heart rate fell significantly (p < 0.001), while median step count and HRV5 significantly increased (p < 0.001). In a multivariate analysis, a delta of HRV5 > 23 ms was an independent predictor for LVEF improvement of ≥10% between prescription and 3-month follow-up. Patients with newly diagnosed HFrEF showed significant changes in heart rate, step count, and HRV5 between the beginning and end of WCD prescription time. HRV5 was an independent predictor for LVEF improvement and could serve as an early indicator of treatment response.
Highlights
Patients with heart failure with reduced ejection fraction (HFrEF) secondary to ischemic or non-ischemic cardiomyopathy may be at high risk for malignant arrhythmias and sudden cardiac death [1,2,3] without meeting implantable cardioverter–defibrillator (ICD) implantation criteria [4]
The present study evaluated for the first-time heart failure parameters recorded via the wearable cardioverter–defibrillator (WCD) in patients with newly diagnosed heart failure
The present study showed an increase in step count per day over time, which reflected an improvement in heart failure symptoms after initiation and up-titrating of heart failure medication
Summary
Patients with heart failure with reduced ejection fraction (HFrEF) secondary to ischemic or non-ischemic cardiomyopathy may be at high risk for malignant arrhythmias and sudden cardiac death [1,2,3] without meeting implantable cardioverter–defibrillator (ICD) implantation criteria [4]. While the primary purpose of the WCD is the prevention of sudden arrhythmic cardiac death, it provides near-continuous telemetric monitoring of parameters of interest in heart failure [15,16]. These parameters, such as heart rate or step count, are accessible via a secure web platform (ZOLL Patient Management Network, ZOLL, Pittsburgh, PA, USA). Patients with newly diagnosed HFrEF are typically discharged on starting doses of guideline-directed medical therapy and are scheduled for a follow-up
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