Remote Monitoring of Pediatric VAD Patients: Early Recognition for Improved Management

Abstract

<h3>Purpose</h3> Over 50% of pediatric durable, discharge-eligible ventricular assist device (VAD) patients are discharged thereby transitioning high-risk patients to outpatient clinics. To enhance management of these patients, our center developed VAD specific content for a home monitoring iPad application (App). We hypothesized that remote monitoring via App + CardioMems Pulmonary Artery Pressure (CMEMS) could reduce risk among outpatient pediatric VAD patients. <h3>Methods</h3> VAD App parameters were developed by our VAD APRN and App company with existing technology for cardiac transplant patients. Manual data entry including VAD speed, output, power, driveline exit site (DLES) picture, residual heart failure symptoms, bleeding, and fluid status, is performed by the patient. The VAD team contacts patient and family if data has not been entered in 2+ days as these platforms are intended for daily trending to enhance remote monitoring. Continuous refinements have been made to the content based on utilization assessment by VAD team and patients. <h3>Results</h3> 13 patients have utilized the VAD App since 2019 for a total of 2519 VAD support days. Median age was 14 years (range 5-16), 7/13 had cardiomyopathy, 10 were supported on HeartMate3 and 3 with HeartWare. Of the 13 patients monitored, 7 were transplanted, 3 are alive and supported, and 2 have died (both destination therapy patients). AE's in this group represent 6 driveline related infections, 2 right heart failures, 4 arrhythmias. We have used CMEMS on 3/13 patients for 457 days of CMEMS monitoring. CMEMS remote monitoring helped recognize two separate episodes of ventricular tachycardia in a patient, allowing for early intervention. Frequent review of App data and CMEMS measurements allows for medical optimization, including diuretic and fluid management without additional clinic and inpatient encounters. Serial image monitoring of DLES directed care for early outpatient intervention of infection. <h3>Conclusion</h3> Remote monitoring in pediatric VAD patients provides more data collection, which augments care of these high-risk patients. Combined use of the App and CMEMS allows for improved optimization of heart failure medications and early recognition of high-risk events. Future study will investigate the impact on hospital admissions and acute heart failure exacerbations.