Physiologist-led management of heart failure patients using cardiac implantable electronic device diagnostics during COVID-19: a 2-year UK perspective

Abstract

Abstract Background/ Introduction The COVID-19 pandemic prompted greater use of remote monitoring capabilities of cardiac implantable electronic devices (CIED). The HeartLogic Index incorporated within certain Boston Scientific CIEDs uses device-derived physiological parameters to generate a score which may be predictive of worsening heart failure (HF). We aimed to define the utility of a novel service, led by cardiac physiologists acting autonomously upon HeartLogic Index alerts, to guide HF patient care during the pandemic. Purpose To assess the utility of a physiologist-led HF service, using CIED diagnostics combined with clinical assessment, to improve HF management. Methods In a single-centre prospective study, 153 Boston Scientific CRT/ICD patients were reviewed over a 2-year period using the integrated HeartLogic algorithm. In response to a HeartLogic alert indicating worsening HF, the patient was contacted by a cardiac physiologist using a structured telephone triage to assess HF symptoms. In those deemed as being at risk of decompensated HF based on clinical assessment, an intervention was made e.g. face-to-face physiologist-led clinical assessment, consultant review, medication optimisation. Results During the 2-year audit, 748 alerts were received from 60 patients, the majority of which had a HF implant indication (n=42). Twenty-one patients within the study population required an intervention due to worsening HF. Following intervention, there were no further hospitalisations within this group. Five hospitalisations were documented during the audit, only 3 of which were HF related. Of these HF hospitalisations, one patient denied HF symptoms at the time of telephone contact, one had a HF decompensation due to deteriorating renal failure and the final patient had a disconnected remote monitor. During the 2-year audit, there were a total of 13 deaths, 3 of which were classified as caused by HF. Conclusion A physiologist-led service may be of clinical utility within this complex patient population, with the audit results demonstrating favourable outcomes with a low rate of mortality and HF hospitalisations. The addition of this service can act to streamline the time from patient presentation to HF review, and therefore improve patient care.