Abstract
Hospitalization due to heart failure (HF) exacerbation represents a major burden in health care and portends a poor long-term prognosis for patients. As a result, there is considerable interest to develop novel tools and strategies to better detect onset of volume overload, as HF hospitalizations may be reduced if appropriate interventions can be promptly delivered. One such innovation is the use of device-based diagnostic parameters in HF patients with implantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy (CRT) devices. These diagnostic algorithms can effectively monitor and detect changes in patients' HF status, as well as predict one's risk of HF hospitalization. This paper will review the role of these device diagnostics parameters in the assessment and management of HF patients in ambulatory settings. In addition, the integration of these novel algorithms in existing HF disease management models will be discussed.
Highlights
Hospitalization for heart failure (HF) is a major health burden upon society, with an estimated prevalence of 5.8 million and an annual incidence of 55 000 in the United States alone [1]
Individual HF diagnostic parameters were collected from the Cardiac Compass report (Figure 2), which consisted of (i) atrial fibrillation (AF) duration; (ii) ventricular rate during AF; (iii) fluid index (OptiVol); (iv) patient activity; (v) night heart rate; (vi) heart rate variability; (vii) percentage of cardiac resynchronization therapy (CRT) pacing; (viii) implantable cardioverter defibrillator (ICD) shocks for ventricular arrhythmias (Figure 1)
The expanding implant indications for ICD and CRT will result in increasing numbers of HF patients receiving these life-saving therapies
Summary
Hospitalization for heart failure (HF) is a major health burden upon society, with an estimated prevalence of 5.8 million and an annual incidence of 55 000 in the United States alone [1]. There is considerable interest to develop strategies that facilitate prompt recognition and management of HF exacerbations in these patients One such innovation is the use of devicebased diagnostic parameters to assess for signs of volume overload and to predict the onset of HF exacerbation. These functions are integrated within the platforms of certain implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices. Among patients with implanted pacing devices, continuous monitoring of HRV could be performed by measurement of the sinus rate from the atrial lead. Measurement of HRV by SDAAM appears to be a valid clinical tool in assessing one’s HF status and risk of subsequent HF hospitalization
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