Remote monitoring in the management of heart failure

Abstract

Remote monitoring (RM) is increasingly being integrated in the management of patients with heart failure (HF) with cardiac implantable electronic devices (CIEDs). The aims were to identify benefits and challenges of RM and to assess the contribution of pulmonary fluid status RM in patients with HF. A literature review was conducted using PubMed® and applying the search terms ‘heart failure’ AND ‘digital health’ AND ‘remote monitoring’ to identify benefits and challenges of RM in HF patients. Inclusion criteria were peer-reviewed articles, available as free full text, in English and published between 2012 and 2021. A cohort study was conducted at the Department of Cardiology of Mater Dei Hospital, including all patients (January 2015-December 2021) diagnosed with HF and with a CIED incorporating a pulmonary fluid status monitoring feature (OptiVolTM 2.0) which tracks intrathoracic impedance changes over time and has the possibility of being monitored remotely. A data collection sheet was developed and validated by an expert panel. Outcomes were assessed over one-year post-CIED implantation using hospital records. From 54 articles screened in the literature review, 25 eligible articles were appraised. Benefits of RM included improved patient health status (n=11), new opportunities to identify and manage risk factors (n=5) and feasibility (n=3). Challenges included cost issues (n=1), data privacy concerns (n=1), maintenance of system efficiency and data quality (n=1). From the cohort of 45 patients assessed (35 male, 20 aged between 71 and 80 years, mean left ventricular ejection fraction 29%, 23 classified as New York Heart Association Class II), 21 patients had RM switched on. Alerts were recorded in 19 of these patients, which led to no action deemed necessary (n=12) or action taken (n=7) by the cardiologist. Actions taken were increase in diuretic dose (n=5), hospital admission (n=3), limiting fluid intake (n=1) and/or increase in dose of disease-modifying drug (n=1). The literature review showed that benefits of RM in patients with HF outweigh the challenges. In practice, pulmonary fluid status RM identified patients who required therapy optimisation in the outpatient setting or hospital admission. More than 50% of the patients opted to have RM switched off, indicating a need for more patient awareness on the benefits of RM.