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. 2021 Aug 15;12(8):4621-4624.
doi: 10.19102/icrm.2021.120802. eCollection 2021 Aug.

Impact of Remote Monitoring on Hospitalizations for Heart Failure: A Five-year Single-center Experience

Jonathan Rosman  1   2 , Murray Rosenbaum  1   2 , Eric Berkowitz  1   2 , E Martin Kloosterman  1   2
Affiliations

Impact of Remote Monitoring on Hospitalizations for Heart Failure: A Five-year Single-center Experience

Jonathan Rosman et al. J Innov Card Rhythm Manag. .

Abstract

The impact of a provider-driven assessment and treatment algorithm based on remote OptiVol (Medtronic, Minneapolis, MN, USA) fluid index levels on hospitalizations for congestive heart failure (CHF) remains unknown. We implemented a physician-guided screening and educational strategy for elevated OptiVol fluid index levels measured on remote implantable cardioverter-defibrillator (ICD) monitoring and assessed clinical outcomes over a five-year period. Patients with CHF and a left ventricular ejection fraction (LVEF) of 40% or less with a previously implanted ICD underwent monthly remote monitoring from January 2015 to November 2019. An OptiVol fluid index of 60 Ω-days or more triggered a protocol-based CHF screening and therapy adjustment according to clinical presentation. Among 279 patients included in the study, 228 (81%) were male and 205 (73%) had ischemic cardiomyopathy. The average LVEF was 29% (± 7.3%). A total of 6,616 monthly transmissions were reviewed over five years; of those, 575 (8.7%) were associated with elevated OptiVol fluid index levels in 178 (64%) patients, and clinical follow-up data were available in 459 of 575 (80%) cases. Following abnormal OptiVol fluid levels on remote monitoring, CHF hospitalization occurred in 10 of 459 (2.2%) patient cases. In conclusion, monthly remote monitoring of OptiVol fluid index levels with a health care provider-guided CHF screening and an educational approach to abnormal OptiVol fluid index levels were associated with a low CHF hospitalization rate. This compared favorably to prior similar studies, and randomized controlled prospective studies evaluating similar algorithms are warranted.

Keywords: Congestive heart failure; defibrillator; intrathoracic impedance; remote monitoring.

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Conflict of interest statement

Dr. Kloosterman serves on the Medtronic advisory committee. The other authors report no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
An example of a patient in the CHF remote monitoring program.
See this image and copyright information in PMC

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