Abstract
Simple SummaryDuring the COVID-19 pandemic, utilization of remote monitoring platforms was recommended. The HeartLogic algorithm identifies patients at risk of heart failure events, combining multiple sensors available on implantable cardioverter defibrillators. This analysis examined how multiple CIED sensors behave in periods of anticipated restrictions pertaining to physical activity. We demonstrated a significant drop in median activity level immediately after the implementation of stay-at-home orders, whereas there was no difference in the other contributing sensors. The weekly rate of heart failure alerts was significantly higher during the lockdown and post-lockdown than that reported in the pre-lockdown. Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.
Highlights
The spread of the coronavirus disease 2019 (COVID-19) epidemic required a rapid response
For this analysis we identified all of the HF patients with reduced left ventricular ejection fraction (≤35% at the time of implantation) who had received a HeartLogic-enabled implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy ICD (CRT-D) (RESONATE family, Boston Scientific) in accordance with standard indications [11] at 20 study centers
We included 349 ICD and cardiac resynchronization therapy ICD patients who had received the device at the study centers before November 2019
Summary
The spread of the coronavirus disease 2019 (COVID-19) epidemic required a rapid response. Stay-at-home orders were issued in many geographies and were shown to result in a rapid global reduction in physical activity [1]. Physical activity is an important determinant of health [2,3]. During the COVID-19 pandemic, hospital admissions for acute cardiac conditions markedly declined [4,5,6] as access to care was impacted by limited hospital resources and by the reluctance of patients to go to hospital. Guidance from the European Society of Cardiology (ESC) for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic [7] encouraged centers to consider telemedicine to provide patients medical advice and follow-ups. For patients with cardiovascular implantable electronic devices (CIEDs), in-person office visits had to be replaced by remote contact, using the device information obtained through remote monitoring [8,9]
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