Home Monitoring Program Research Articles

The SElf-Care After REnal Transplantation Study: A Retrospective Evaluation of a Home-Monitoring Program Implemented as Standard Care.

After transplantation self-management is essential for graft survival and optimal quality of life. To address the need for home-based support in self-management, we implemented the "SelfCare after Renal Transplantation" (SeCReT) box, containing home-monitoring equipment combined with a smartphone application that was linked to the electronic patient records. This study investigated the uptake and continuation, protocol adherence, and subjective evaluation of this home-monitoring program. All "de novo" kidney recipients who received the SeCReT-box in the study period (Aug 2021-Dec 2022) were eligible for inclusion. Protocol adherence was defined as ≥75%. Subjective evaluation was assessed with a 5-item questionnaire. Of the 297 recipients transplanted, 178 participants (60%) were included in the analysis. Protocol adherence was 83%, 73%, 66%, and 57% respectively at 5, 10, 20, and 40weeks of the protocol. With regard to continuation, 135 participants were still in the program at the end of the study period (75% retention rate). Regarding subjective evaluations, 82% evaluated the program positively, and 52% reported lower care needs due to home-monitoring. Results are positive among those who entered and continued the program. Qualitative research is needed on barriers to entering the program and facilitators of use in order to promote optimal implementation.

Impact of home monitoring program on interstage mortality after the Norwood procedure.

While early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, interstage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) decrease interstage mortality. Among 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding interstage mortality. In patients with HMP, events during the interstage period were evaluated. Interstage mortality was 8% (n = 21), and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with interstage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extra corporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for interstage mortality. Most frequent event during home monitoring was low saturation (<70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnated weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmias in 2 (2.5%). An unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups. Interstage HMP permits timely intervention and led to an important decrease in interstage mortality. One-third of the patients with home monitoring program needed re-admission and demonstrated the need for earlier stage 2 palliation.

Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program.

Background Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP). Methods and Results We performed a retrospective single-center study of infants with hypoplastic left heart syndrome before (2007-2010) and after (2011-2020) introduction of the ISVMP. The primary outcome was interstage weight gain, and the secondary outcome was interstage growth failure. Multivariable linear and logistic regression models were used to examine the association between the Social Vulnerability Index and the outcomes. We introduced an interaction term into the models to test for effect modification by the ISVMP. We evaluated 217 ISVMP infants and 111 pre-ISVMP historical controls. The Social Vulnerability Index was associated with interstage growth failure (P=0.001); however, enrollment in the ISVMP strongly attenuated this association (P=0.04). Pre-ISVMP, as well as high- and middle-vulnerability infants gained 4 g/d less and were significantly more likely to experience growth failure than low-vulnerability infants (high versus low: adjusted odds ratio [aOR], 12.5 [95% CI, 2.5-62.2]; middle versus low: aOR, 7.8 [95% CI, 2.0-31.2]). After the introduction of the ISVMP, outcomes did not differ by Social Vulnerability Index tertile. Infants with middle and high Social Vulnerability Index scores who were enrolled in the ISVMP gained 4 g/d and 2 g/d more, respectively, than pre-ISVMP controls. Conclusions In infants with hypoplastic left heart syndrome, high social vulnerability is a risk factor for poor interstage weight gain. However, enrollment in the ISVMP significantly reduces growth disparities.

Patient Experience in a COVID-19 Patient Home Monitoring Program

Patients who participated in a COVID-19 patient home monitoring program were satisfied with their care and stated that their participation made them less likely to seek care in the emergency department.

Effectiveness of a home-based telesurveillance program in reducing hospital readmissions in older patients with chronic disease: The eCOBAHLT randomized controlled trial.

Given that chronic, long-term conditions are increasingly common in older patients, the impact of telesurveillance program on clinical outcomes is uncertain. This study aimed to evaluate the feasibility and effectiveness of a 12-month remote monitoring program in preventing rehospitalizations in older patients with two or more chronic diseases returning home after hospitalization. We conducted a multicenter randomized controlled trial in two parallel groups to evaluate the remote monitoring system. Elderly patients with chronic diseases (at least two comorbidities) aged 65 years or older and discharged home after acute hospital care for a chronic disease were randomized to receive a home telemonitoring program (intervention group, n = 267) or conventional care (control group, n = 267). The remote home monitoring program was an online biometric home life analysis technology (e-COBAHLT) with tele-homecare/automation and biometric sensors. The eCOBALTH intervention group received the automation sensors containing chronic disease clinical factor trackers to monitor their biometric parameters and detect any abnormal prodromal disease decompensation by remote monitoring and providing geriatric expertise to general practitioners. The usual care group received no eCOBALTH program. In both groups, baseline visits were conducted at baseline and the final visit at 12 months. The primary outcome was the incidence of unplanned hospitalizations for decompensation during the 12-month period. Among 534 randomized participants (mean [SD] age, 80.3 [8.1] years; 280 [52.4%] women), 492 (92.1%) completed the 12-month follow-up; 182 (34.1) had chronic heart failure, 115 (21.5%) had stroke, and 77 (14.4%) had diabetes. During the 12-month follow-up period, 238 patients had at least one unplanned hospitalization for decompensation of a chronic disease: 108 (40.4%) in the intervention group versus 130 (48.7%) in the control group (P = 0.04). The risk of rehospitalization was significantly reduced in the intervention group (age- and sex-adjusted relative risk: 0.72, 95% 95% confidence intervals 0.51-0.94). A 12-month home telemonitoring program with online biometric analysis using Home life technology combining telecare and biometric sensors is feasible and effective in preventing unplanned hospitalizations for chronic disease decompensation in elderly patients with chronic diseases at high risk for hospitalizations.

Hospital Days Reduced for Moderate and Severe COVID-19 Patients Through a Home Monitoring Program With Oxygen.

While the COVID-19 pandemic continues to strain the healthcare system, it has also expanded telemedicine. There is a subset of hospitalized moderate to severe COVID-19 patients requiring oxygen but no other intervention. This is a retrospective study of patients ≥18 years with moderate to severe COVID-19 that participated in a home monitoring program with supplemental oxygen (HMP-O2) (N = 25). For study outcomes, HMP-O2 participants were compared to patients meeting the same inclusion criteria but did not participate in the program (N = 60). On average, the HMP-O2 patients spent 5.8 days (±5.5 days) in the hospital compared to 8.12 days (±5.5 days) for non-program patients. This resulted in 19% cost-savings for HMP-O2 patients. Lessons learned from this program can be applied to future HMPs for either COVID-19 or other conditions that would benefit from telecare.

Study protocol of an international patient-led registry in patients with pulmonary fibrosis using online home monitoring: I-FILE

BackgroundPulmonary fibrosis (PF) is caused by a heterogeneous group of diseases, with a high inter-individual variability in disease trajectory. Identifying disease progression in patients with PF has impact on clinical management decisions. However, strategies to early identify and predict disease progression for these patients are currently lacking. In this study, we aim to assess long-term FVC change in patients with PF measured with home spirometry, and evaluate the feasibility of a multinational patient-led registry in PF. In addition, we will assess validity of patient-reported outcomes (PROMs) for the different subgroups of patients with PF.MethodsIn this international, prospective, multicenter, observational study, we aim to include 700 patients across seven European countries. Patients will monitor their disease course for a period of two years using an online home monitoring program (I-FILE), which includes home spirometry, pulse oximetry, and PROMs. Results will be directly sent to the hospital via the online application. Patients will be asked to perform daily home spirometry and pulse oximetry in the first three months, followed by once weekly measurements for a period of two years. PROMs will be completed in the online I-FILE application every six months, including the King’s brief Interstitial Lung Disease Health Status, The EuroQol five dimensions five-level, Visual Analogue Scales on cough, dyspnea, fatigue and general complaints, Leicester Cough Questionnaire, Fatigue Assessment Scale, Work Productivity and Activity Impairment Questionnaire, Global Rating of Change Scale, and Living with Pulmonary Fibrosis questionnaire.DiscussionThis study will provide much needed insights in disease trajectories of the different subgroups of patients with PF. Simultaneously, the I-FILE study will yield valuable information on the use and feasibility of home-based data collection. This international patient-led registry will facilitate trans-border collaboration to further optimize care and research for patients with PF.Trial registration: The study was registered on the 12th of March 2020 in the International Clinical Trial Registry, www.clinicaltrials.gov; Identifier: NCT04304898.

Interstage mortality among infants with hypoplastic left heart syndrome: Outcomes of a multicenter home monitoring program

BackgroundInterstage mortality remains a risk for children with hypoplastic left heart syndrome (HLHS). Decreased mortality has resulted from interstage home monitoring (IHM) programs. The Stollery Children's Hospital has had an IHM program in place since 2003 in collaboration with multiple regional non-surgical pediatric cardiology programs located across Western Canada. ObjectivesWe sought to determine the incidence of interstage mortality and risk factors for interstage death across this large geographic region. MethodsRetrospective cohort study including all infants with HLHS who underwent Norwood-Sano surgery between January 2006 and June 2019. Home monitoring consisted of an infant weight scale and pulse oximetry with parental education prior to discharge post Norwood-Sano. Parents were advised to weigh their infant and check oxygen saturation every day and contact their cardiology team if there were desaturations, weight loss, poor feeding, fever or other concerns. Outpatient assessment was planned biweekly. ResultsThere were one hundred and sixty-five infants who met eligibility criteria. Twenty-three infants (14 %) died prior to Glenn; of these, 18 (11 %) had in-hospital death, and 5 (3.5 %) of 142 discharged patients had an out-of-hospital (interstage) death. Three infants (2 %) underwent heart transplantation prior to Glenn, and 137 (83 %) survived to Glenn. Risk factors for interstage death could not be determined due to the rarity of this outcome. ConclusionThe out-of-hospital interstage mortality that we observed was lower than many previous reports, suggesting that implementation of this IHM program across a large geographic area, including multiple non-surgical sites, was successful. Additional investigations regarding the potential impact of designated care teams and virtual interstage care delivery are warranted in this vulnerable population.

1040. Comparative Surge Data on SARS CoV-2 Variants in a Rural Community – A Virtual Hospital Experience

Abstract Background UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges. Methods From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this abstract, we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of &amp;gt;10 patients. We defined the maximum intensity of the surge as &amp;gt;20% outpatient SARS CoV-2 positivity and a CVH census &amp;gt;100 patients or &amp;gt;20 inpatients with SARS CoV-2 infection. Results For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron. Conclusion Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care. Disclosures All Authors: No reported disclosures.

Abstract 10463: Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program

Introduction: Interstage (IS) growth failure is a risk factor for poor outcomes in infants with hypoplastic left heart syndrome (HLHS). We hypothesize that children with greater social vulnerability are at greater risk for IS growth failure. However, IS home monitoring may mitigate disparities in IS weight gain. We sought to examine the impact of an Infant Single Ventricle Management and Monitoring Program (ISVMP) on the association of neighborhood social vulnerability and IS weight gain. Methods: We performed a retrospective single-center cohort study of infants with HLHS before (2007-2010) and after (2011-2020) the introduction of the ISVMP. IS weight gain was measured in grams per day (gm/day) and growth failure was defined as an average IS weight gain of &lt;20 gm/day. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI) with higher SVI values representing greater vulnerability. Linear and logistic regression models were used to examine the association between SVI and IS weight gain and growth failure. Models were adjusted for demographic, operative, and discharge characteristics. To test for effect modification by ISVMP, we introduced an interaction term into the models and calculated pre- and post- stratum-specific effect estimates. Results: In total, 328 infants with HLHS, were evaluated 111 before and 217 after the introduction of the ISVMP. In the total cohort, SVI was significantly associated with IS growth failure (P= 0.001). Enrollment in ISVMP strongly attenuated the association of SVI and IS growth failure (P = 0.04). Prior to ISVMP, infants in the highest and middle SVI tertiles gained 4 gm/day less than infants in the lowest SVI tertile and were more likely to experience IS growth failure (high vs. low: aOR 12.5; 95% CI 2.5-62.2; middle vs. low: aOR 7.8; 95% CI 2.0-31.2). However, after the introduction of the ISVMP, there was no difference in IS weight gain or growth failure by SVI tertile. Middle and high SVI infants enrolled in ISVMP gained 4 gm/day and 2 gm/day more than their pre-ISVMP counterparts, respectively. Conclusion: High social vulnerability is a risk factor for poor IS weight gain in infants with HLHS. However, enrollment in ISVMP significantly reduces growth disparities.

COVID-box Experiences of Patients and Health Care Professionals (COVID-box Project): Single-Center, Retrospective, Observational Study.

BackgroundDuring the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals.ObjectiveThe objective of our study was to determine patients’ and health care professionals’ experiences and satisfaction with employing the COVID-box.MethodsIn this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale.ResultsA total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10).ConclusionsThe positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program—the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems.

Utilizing technology to expand home monitoring to high-risk infants with CHD.

Infants born with single ventricle physiology that require an aorto-pulmonary shunt are at high risk for sudden cardiac death, particularly during the interstage period between the first-stage palliation and the second-stage palliation. Home monitoring programs have decreased interstage mortality in the hypoplastic left heart syndrome population prompting programs to expand the home monitoring program to other high-risk populations. At our mid-sized program, we implemented the Locus Health home monitoring platform first in the hypoplastic left heart syndrome population, then expanding to the single ventricle shunt population. Interstage mortality for the hypoplastic left heart syndrome population after initiation of the home monitoring program went from 18% prior to 2009 to 7% as of the end of 2020 (n = 99), with 2.8% mortality from 2013 to 2020 and 0% mortality since initiation of the Locus program in 2017. Caregiver surveys done prior to discharge and then 3 weeks later were used to document caregiver experience using the digital home monitoring program. Caregivers reported overall positive experience with the digital application, with 91.8% stating that they felt confident taking care of their baby at home. Transitioning the home monitoring program from a traditional binder to an iPad with the Locus Health application allowed us to expand the program, utilize the electronic medical record, bill for the service, and demonstrate positive experiences for caregivers. Overall engagement and adherence with the program by caregivers were 50.94 and 45.45%, with a total of 112 patient episodes. Reimbursement from private insurance providers was 22% of the billed amount for 2020.

Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish.

BackgroundTelemedicine is a vital component of the healthcare system’s response to COVID-19. In March of 2020, Providence health system rapidly implemented a telemedicine home monitoring program (HMP) for COVID-19 patients that included use of at-home pulse oximeters and thermometers and text-based surveys to monitor symptoms. By June 2020, Providence updated the HMP to be offered in Spanish. This program was implemented before COVID-19 testing was readily available and therefore was offered to all patients suspected of having COVID-19. This study examines engagement, experience, and utilization patterns for English and Spanish-speaking patients engaged in the COVID-19 HMP.MethodsA retrospective review of program data was used to understand HMP patient engagement (responsiveness to three daily text to monitor symptoms), satisfaction with the program (likelihood to recommend the program) as well as comfort using home monitoring devices and comfort recovering from home. To understand impact on care for COVID-19 confirmed cases, we used electronic health records to measure patterns in healthcare use for COVID-19 positive HMP participants and non-HMP propensity weighted controls. All patients enrolled in the COVID-19 HMP from March–October 2020 were included in the study. Patients tested for COVID-19 during the time window and not enrolled in HMP were included in the propensity-weighted comparison group. Descriptive and regression analyses were performed overall and stratified by English and Spanish speakers.ResultsOf the 4,358 HMP participants, 75.5% identified as English speakers and 18.2% identified as Spanish speakers. There was high level of responsiveness to three daily text-based surveys monitoring symptoms engagement (>80%) and a high level of comfort using the home monitoring devices (thermometers and pulse oximeters) for English- and Spanish-speaking participants (97.3% and 99.6%, respectively). The majority of English (95.7%) and Spanish-speaking (100%) patients felt safe monitoring their condition from home and had high satisfaction with the HMP (76.5% and 83.6%, respectively). English and Spanish-speaking COVID-19 positive HMP participants had more outpatient and emergency departments (ED) encounters than non-participants 7 and 30 days after their positive test.ConclusionThis widely implemented HMP provided participants with a sense of safety and satisfaction and its use was associated with more outpatient care and ED encounters. These outcomes were comparable across English and Spanish-speakers, highlighting the importance and potential impact of language-concordant telemedicine.

Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation.

Nutritional management and home monitoring programs (HMPs) may be beneficial for improving interstage morbidity and mortality following stage I Norwood palliation (S1P) for hypoplastic left heart syndrome (HLHS). We recognized an increasing trend towards early feeding gastrostomy tube (GT) placement prior to discharge in our institution, and we aimed to investigate the effect of HMPs and GTs on interstage mortality and growth parameters. Single-institutional review at a tertiary referral center between 2008 and 2018. Individual patient charts were reviewed in the electronic medical record. Those listed for transplant or hybrid procedures were excluded. Baseline demographics, operative details, and interstage outcomes were analyzed in GT and non-GT patients (nGT). Our HMP was instituted in 2009, and patients were analyzed by era: I (early, 2008-2012), II (intermediate, 2013-2016), and III (recent, 2017-2018). 79 patients were included in the study: 29 nGTs and 50 GTs. GTs had higher number of preoperative risk factors more S1P complications, longer ventilation times, longer lengths of stay, and shorter times to readmission. There were no differences in interstage mortality or overall mortality between groups. There was one readmission for a GT-related issue with no periprocedural complications in the group. Weight gain doubled after GT placement in the interstage period while waiting periods for placement decreased across Eras. HMPs and early GTs, especially for patients with high-risk features, provide a dependable mode of nutritional support to optimize somatic growth following S1P.

Evaluating the congenital heart assessment tool: a quality improvement project.

An early warning tool, the Congenital Heart Assessment Tool (CHAT), was designed in 2012 to support parental preparation before discharge, enhancing understanding of their infant's complex CHD, the signs of deterioration to look out for and to support decision-making at home. Acceptability and feasibility of the tool were tested during 2013-2015 in a single centre. To evaluate the wider implementation across four children's cardiac centres of the CHAT for infants with complex CHD in the community setting. A four-centre collaborative mixed-methods quality improvement project funded by The Health Foundation, during 2016-2018. A plan, do, study, act cycle of improvement was employed. This article reports on the planning phases, creation of a modified tool (CHATm); and the implementation phases, including retrospective case note review using CHATm; tabletop simulation exercise using CHATm and clinical implementation of CHATm. Key findings included the benefit of using CHATm simulation for practitioners; the effectiveness of CHATm in predicting amber and red triggers, indicating parental actions and escalation of concerns to professionals. Parents using CHATm found it enhanced knowledge in preparation for going home, supported decision-making, and discussions with health care professionals. Using the CHATm clinically identified the need to develop a structured model of assessment of parental suitability for home-monitoring programmes. A robust and nationally agreed training programme for all staff using CHATm was recommended to ensure successful and complete implementation in practice.

New insights on growth trajectory in infants with complex congenital heart disease

PurposeWe aimed to describe the weight-for-age Z-score growth trajectory (WAZ-GT) of infants with complex congenital heart disease (cCHD) after neonatal cardiac surgery in the first 4 months of life and assess potential risk factors. MethodsWe utilized data from a previously reported trial of the REACH telehealth home monitoring (NCT01941667) program which evaluated 178 infants with cCHD from 2012 to 2017. Over the first 4 months of life, weekly infant weights were converted to WAZ. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between potential risk factors and WAZ-GT classes. ResultsFour distinct classes of WAZ-GT were identified: maintaining WAZ > 0, 14%; stable around WAZ = 0, 35%; partially recovered, 28%; never recovered, 23%. Compared with reference group “stable around WAZ=0,” we identified clinical and sociodemographic determinants of class membership for the three remaining groups. “Maintaining WAZ > 0” had greater odds of having biventricular physiology, borderline appetite, and a parent with at least a college education. “Partially recovered” had greater odds of hospital length of stay>14 days and being a single child in the household. “Never recovered” had greater odds hospital length of stay >14 and > 30 days, tube feeding at discharge, and low appetite. ConclusionsThis study described distinct classes of WAZ-GT for infants with cCHD early in infancy and identified associated determinants. Practice implicationsFindings from this study can be used in the identification of infants at risk of poor WAZ-GT and in the design of interventions to target growth in this vulnerable patient population.

Temporal trend of QRS voltage amplitude on surface sensing in patients with arrhythmogenic cardiomyopathy implanted with a subcutaneous ICD

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Previous studies have reported a significant decrease in ventricular sensing amplitude during follow-up in patients with arrhythmogenic cardiomyopathy (ACM) implanted with trans-venous implantable cardioverter defibrillator (ICD). No data are yet available on sensing amplitudes values over time for subcutaneous ICD (S-ICD). Low QRS voltage on surface ECG is one of the diagnostic clues in ACM. This, together with the progressive nature of the disease and the not-negligible incidence of inappropriate shocks due to oversensing, raise safety concerns on the use of S-ICD in this population. Aim The aim of this study was to evaluate the trend of QRS amplitude on subcutaneous ECG (S-ECG) over time in patients with ACM implanted with S-ICD. Methods We conducted a retrospective analysis on a cohort of consecutive patients with ACM implanted with S-ICD in two tertiary centers, prospectively enrolled in the home-monitoring program. The S-ECGs recorded by the S-ICD at the time of first and last data transmission were analyzed. The voltage amplitude was estimated for each QRS complex available, and the values obtained were compared between the two time points (i.e. baseline and last follow-up available). The primary endpoint of our study was the proportion of patients in which the decrease of QRS amplitude during follow-up was statistically significant. Results Eleven patients (1 female, 9%) were enrolled in this study. The mean age was 43±10 years. An exclusive right ventricular involvement was reported in 5 patients (46%), 2 patients (18%) had an exclusive left ventricular, and 4 (36%) a biventricular involvement. Three patients (27%) were implanted in secondary prevention. During a median follow-up of 9 months (IQR 6-17), 6 patients (55%, 95%CI 24-84%) experienced a statistically significant reduction in the S-ECG QRS amplitude (Figure A). Considering these 6 patients, the mean absolute reduction was -0.46±0.32 mV corresponding to a relative reduction of -19%±11%. Moreover, we found a statistically significant correlation between follow-up duration and QRS amplitude relative reduction (r=-0.89, p=0.018, Figure B). No patients experienced inappropriate shocks. Conclusions In a cohort of ACM patients implanted with S-ICD the majority of patients experienced a significant reduction in the amplitude of QRS voltage during follow-up, confirming a potential safety concern on the use of S-ICD in this population. Further studies are needed to investigate this issue.

P9 TEMPORAL TREND OF QRS VOLTAGE AMPLITUDE ON SURFACE SENSING IN PATIENTS WITH ARRHYTHMOGENIC CARDIOMYOPATHY IMPLANTED WITH A SUBCUTANEOUS ICD

Abstract Introduction Previous studies have reported a significant decrease in ventricular sensing amplitude during follow–up in patients with arrhythmogenic cardiomyopathy (ACM) implanted with trans–venous implantable cardioverter defibrillator (ICD). No data are yet available on sensing amplitude values over time for subcutaneous ICD (S–ICD). Low QRS voltage on surface ECG is one of the diagnostic clues in ACM. This, together with the progressive nature of the disease and the not–negligible incidence of inappropriate shocks due to oversensing, raise safety concerns on the use of S–ICD in this population. The aim of this study was to evaluate the trend of QRS amplitude on subcutaneous ECG (S–ECG) over time in patients with ACM implanted with S–ICD. Methods We conducted a retrospective analysis on a cohort of consecutive patients with ACM implanted with S–ICD in two Italian tertiary centers, prospectively enrolled in the home–monitoring program. The S–ECGs recorded at the time of first and last data transmission were analyzed. The voltage amplitude was estimated for each QRS complex available, and the values obtained were compared between the two time points (i.e. baseline and last follow–up available). The primary endpoint of our study was the proportion of patients in which the decrease of QRS amplitude during follow–up was statistically significant. Results Eleven patients (1 female, 9%) were enrolled in this study. The mean age was 43±10 years. An exclusive right ventricular involvement was reported in 5 patients (46%), 2 patients (18%) had an exclusive left ventricular, and 4 (36%) a biventricular involvement. Three patients (27%) were implanted in secondary prevention. During a median follow–up of 9 months (IQR 6–17), 6 patients (55%, 95%CI 24–84%) experienced a statistically significant reduction in the S–ECG QRS amplitude (Fig. A). Considering these 6 patients, the mean absolute reduction was –0.46±0.32 mV corresponding to a relative reduction of –19%±11%. Moreover, we found a statistically significant correlation between follow–up duration and QRS amplitude relative reduction (r=–0.89, p = 0.018, Fig. B). No patients experienced inappropriate shocks. Conclusions In a cohort of ACM patients implanted with S–ICD the majority of patients experienced a significant reduction in the amplitude of QRS voltage during follow–up, confirming a potential safety concern on the use of S–ICD in this population. Further studies are needed to investigate this issue.

Performance of a single-ventricle home-monitoring programme: survival and predictors of adverse outcome.

Mortality between stages 1 and 2 single-ventricle palliation is significant. Home-monitoring programmes are suggested to reduce mortality. Outcomes and risk factors for adverse outcomes for European programmes have not been published. To evaluate the performance of a home-monitoring programme at a medium-sized United Kingdom centre with regards survival and compare performance with other home-monitoring programmes in the literature. All fetal and postnatal diagnosis of a single ventricle were investigated with in-depth analysis of those undergoing stage 1 palliation and entered the home-monitoring programme between 2016 and 2020. The primary outcome was survival. Secondary outcomes included multiple parameters as potential predictors of death or adverse outcome. Of 217 fetal single-ventricle diagnoses during the period 2016-2020, 50.2% progressed to live birth, 35.4% to stage 1 and 29.5% to stage 2. Seventy-four patients (including 10 with postnatal diagnosis) entered the home-monitoring programme with six deaths making home-monitoring programme mortality 8.1%. Risk factors for death were the hybrid procedure as the only primary procedure (OR 33.0, p < 0.01), impaired cardiac function (OR 10.3, p < 0.025), Asian ethnicity (OR 9.3, p < 0.025), lower mean birth-weight (2.69 kg versus 3.31 kg, p < 0.01), and lower mean weight centiles during interstage follow-up (mean centiles of 3.1 versus 10.8, p < 0.01). Survival in the home-monitoring programme is comparable with other home-monitoring programmes in the literature. Hybrid procedure, cardiac dysfunction, sub-optimal weight gain, and Asian ethnicity were significant risk factors for death. Home-monitoring programmes should continue to raise awareness of these factors and seek solutions to mitigate adverse events. Future work to generalise home-monitoring programme and single-ventricle fetus to stage 2 outcomes in the United Kingdom will require multi-centre collaboration.

Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center

Introduction Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. Methods We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. Results Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). Discussion Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.