Nursing protocol for heart failure remote monitoring in patients with ICD/CRT with a 5 variable multiparametric tool

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Many patients with heart failure (HF) suffer from decompensation that sometimes leads to hospitalizations, harming prognosis and quality of life. Some cardiac implantable electronic devices (CIEDs) allow the transmission of clinical data online, providing helpful information without the patient having to go to a face-to-face consultation, which usually takes no less than 25 minutes. Moreover, a 5-variable multiparametric tool (S1 and S3 heart sounds, pulmonary congestion through a thoracic impedance, volume and respiratory rate, night heart rate) expresses a heart failure index (HM-5) incorporated into some CIEDs, capable of predicting 34 days before HF decompensation episodes when the reported index is ≥16, with a sensitivity of 70%. According to this warning, transmissions with a potential risk of HF exacerbation should be classified. Ideally, reviewing these warnings should not take more time than is invested in the face-to-face follow-up. Purpose Create a protocol with a risk classification according to the heart failure index and compare the duration of face-to-face and remote online follow-up performed by the same nursing staff in patients with CIEDs with a heart failure index activated in the arrhythmia consultation in a tertiary hospital. Methods First, we created a colour scale protocol (red alert: urgent event, yellow alert: important event and green alert: normal state) classifying heart failure index alerts during one year (January – December 2021) (See figure 1). Patient clinical characteristics, and duration of face-to-face & remote monitoring follow-ups were registered, quantifying the time spent reviewing each patient. Results Twenty-two patients with CIEDs and HM-5 tool activated were included; 28% were female, 72% had hypertension, 40,9% had diabetes mellitus, 22,7% had chronic kidney disease, and the mean left ventricle ejection fraction was 36,18%, half of them has ischaemic cardiomyopathy. The annexed protocol was followed with the help of the medical health record platform that classified the transmissions according to a colour scale. The rate of alerts/patient-year was 0.97; 22% of yellow alerts were related to HF. The mean time nursing review face-to-face versus remote was 16.55 min vs 3.05 min (p<0.001) (table 1). Conclusion Remote follow-up by the nursing staff of patients with HF and ICD provided with a 5-variable multiparametric tool is strict and protocolized in our hospital. It requires less time compared to face-to-face review.