Multiparameter diagnostic sensor measurements in heart failure patients presenting with SARS-CoV-2 infection

Abstract

Aims: Implantable device-based sensor measurements including heart sounds, markers of ventilation, and thoracic impedance have been shown to predict heart failure (HF) hospitalizations. We sought to assess how these parameters changed prior to COVID-19 (Cov-19) and how these compared with those presenting with decompensated HF or pneumonia.

Methods and results: This retrospective analysis explores patterns of changes in daily measurements by implantable sensors in 10 patients with Cov-19 and compares these findings with those observed prior to HF (n = 88) and pneumonia (n = 12) hospitalizations from the MultiSENSE, PREEMPT-HF, and MANAGE-HF trials. The earliest sensor changes prior to Cov-19 were observed in respiratory rate (6 days) and temperature (5 days). There was a three-fold to four-fold greater increase in respiratory rate, rapid shallow breathing index, and night heart rate compared with those presenting with HF or pneumonia. Furthermore, activity levels fell more in those presenting with Cov-19, a change that was often sustained for some time. In contrast, there were no significant changes in 1st or 3rd heart sound (S₁ and S₃ ) amplitude in those presenting with Cov-19 or pneumonia compared with the known changes that occur in HF decompensation.

Conclusions: Multi-sensor device diagnostics may provide early detection of Cov-19, distinguishable from worsening HF by an extreme and fast rise in respiratory rate along with no changes in S3.

Keywords: Ambulatory monitoring; COVID-19; CRT; Heart failure; ICD; SARS-Cov-2.

Figure 1

Mean relative change in sensor data between baseline and prior to COVID‐19, pneumonia, and heart failure events. Pre‐event sensor changes were calculated based on a fixed baseline (60 to 30 day prior to the event) for all three disease events.

Figure 2

(A) Mean sensor trends leading up COVID‐19 diagnosis (day 0). Solid line denotes mean sensor value with surrounding shading representing SEM. Blue dashed line, baseline; green line, earliest rise. (B) Comparison of mean sensor changes trends leading to a COVID‐19 diagnosis (day 0), a decompensated heart failure event (day 0), or hospitalization for pneumonia (day 0). Solid line denotes mean percent change from baseline, with surrounding shading representing SEM. Dashed lines denote earliest rise from baseline. Red = COVID‐19, green = heart failure, blue = pneumonia.

Figure 3

Patient‐specific sensor changes between baseline and the period prior to COVID‐19 events. Each row displays a specific COVID‐19 patient's sensor change status. A patient's sensor increase or decrease is determined when the sensor difference at pre‐event is greater than or equal to 1 standard deviation of their own baseline.