TY  - JOUR
A1  - Sack, Stefan
A1  - Wende, Christian Michael
A1  - Nägele, Herbert
A1  - Katz, Amos
A1  - Bauer, Wolfgang Rudolf
A1  - Barr, Craig Scott
A1  - Malinowski, Klaus
A1  - Schwacke, Harald
A1  - Leyva, Francisco
A1  - Proff, Jochen
A1  - Berdyshev, Sergey
A1  - Paul, Vincent
T1  - Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study
JF  - European Journal of Heart Failure
N2  - Aim

To investigate whether diagnostic data from implanted cardiac resynchronization therapy defibrillators (CRT-Ds) retrieved automatically at 24 h intervals via a Home Monitoring function can enable dynamic prediction of cardiovascular hospitalization and death.

Methods and results

Three hundred and seventy-seven heart failure patients received CRT-Ds with Home Monitoring option. Data on all deaths and hospitalizations due to cardiovascular reasons and Home Monitoring data were collected prospectively during 1-year follow-up to develop a predictive algorithm with a predefined specificity of 99.5%. Seven parameters were included in the algorithm: mean heart rate over 24 h, heart rate at rest, patient activity, frequency of ventricular extrasystoles, atrial–atrial intervals (heart rate variability), right ventricular pacing impedance, and painless shock impedance. The algorithm was developed using a 25-day monitoring window ending 3 days before hospitalization or death. While the retrospective sensitivities of the individual parameters ranged from 23.6 to 50.0%, the combination of all parameters was 65.4% sensitive in detecting cardiovascular hospitalizations and deaths with 99.5% specificity (corresponding to 1.83 false-positive detections per patient-year of follow-up). The estimated relative risk of an event was 7.15-fold higher after a positive predictor finding than after a negative predictor finding.

Conclusion

We developed an automated algorithm for dynamic prediction of cardiovascular events in patients treated with CRT-D devices capable of daily transmission of their diagnostic data via Home Monitoring. This tool may increase patients’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies.
KW  - Remote device monitoring
KW  - Multiparameter predictor
KW  - Cardiovascular hospitalizations
KW  - Heart failure
KW  - Home monitoring
KW  - Cardiac resynchronization therapy defibrillator
Y1  - 2011
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141709
VL  - 13
IS  - 9
ER  -