Value of implant-based telemonitoring in the high-risk population of ventricular assist device patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Telemonitoring of heart failure (HF) patients is an evolving field. Prior studies presented promising results. However, the relevance of telemonitoring in the specific cohort of end-stage HF patients on ventricular assist device (VAD) therapy has not been analysed yet. Purpose This study aimed to evaluate the benefit of daily implant-based multiparameter-telemonitoring in high-risk HF-patients on VAD therapy with an implantable cardioverter-defibrillator (ICD) or a cardiac resynchronization defibrillator (CRT-D) including telemonitoring function. Beyond that, patients’ outcome and complication rates were evaluated. Methods A total of 30 end-stage HF-patients (65 ± 10 years, 89 % male) with a VAD and an ICD or a CRT-D with telemonitoring function were included in this observational single center study. Long-term follow-up data (4.28 ± 2.62 years) were assessed. Results All patients (n=30, 100%) received daily ICD or CRT-D telemonitoring. In the majority of patients (73%, n=22) the telemedical center had to take actions a mean of 3 times. Most events (84%, n=45) were identified within 24 hours. An acute alert due to sustained ventricular arrhythmias (VAs) occurred in 13 patients (65%) with 46% of them (n=6) requiring a shock delivery. Eight patients (62%) were hospitalized due to symptomatic VAs. Inadequate shocks were recognized in 3 patients (23%). In 12 patients (92%) immediate medication adjustments were recommended. Relevant lead problems were revealed in 13 patients (43%) with 6 patients (46%) undergoing consecutive lead revisions. Device-reprogramming was recommended in 50% of all VAD-patients (n=15). Compared to HF-patients without remote monitoring, daily telemonitoring significantly reduced the number of in-hospital device controls by 44% (p<0.01). Conclusions Daily implant-based-telemonitoring increased patient safety as it allowed for pre-emptive interventions and an immediate detection of cardiac arrhythmias and device/lead problems. Even in this high-risk HF-patient population, telemonitoring significantly reduced the number of in-hospital device-controls. Further studies are warranted to confirm these initial observations.