Remotely Monitored Cardiac Implantable Electronic Device Data Predict All-Cause and Cardiovascular Unplanned Hospitalization

Abstract

Background Unplanned hospitalizations are common in patients with cardiovascular disease. The "Triage Heart Failure Risk Status" (Triage-HFRS) algorithm in patients with cardiac implantable electronic devices uses data from up to 9 device-derived physiological parameters to stratify patients as low/medium/high risk of 30-day heart failure (HF) hospitalization, but its use to predict all-cause hospitalization has not been explored. We examined the association between Triage-HFRS and risk of all-cause, cardiovascular, or HF hospitalization. Methods and Results A prospective observational study of 435 adults (including patients with and without HF) with a Medtronic Triage-HFRS-enabled cardiac implantable electronic device (cardiac resynchronization therapy device, implantable cardioverter-defibrillator, or pacemaker). Cox proportional hazards models explored association between Triage-HFRS and time to hospitalization; a frailty term at the patient level accounted for repeated measures. A total of 274 of 435 patients (63.0%) transmitted ≥1 high HFRS transmission before or during the study period. The remaining 161 patients never transmitted a high HFRS. A total of 153 (32.9%) patients had ≥1 unplanned hospitalization during the study period, totaling 356 nonelective hospitalizations. A high HFRS conferred a 37.3% sensitivity and an 86.2% specificity for 30-day all-cause hospitalization; and for HF hospitalizations, these numbers were 62.5% and 85.6%, respectively. Compared with a low Triage-HFRS, a high HFRS conferred a 4.2 relative risk of 30-day all-cause hospitalization (8.5% versus 2.0%), a 5.0 relative risk of 30-day cardiovascular hospitalization (3.6% versus 0.7%), and a 7.7 relative risk of 30-day HF hospitalization (2.0% versus 0.3%). Conclusions In patients with cardiac implantable electronic devices, remotely monitored Triage-HFRS data discriminated between patients at high and low risk of all-cause hospitalization (cardiovascular or noncardiovascular) in real time.

Keywords: all‐cause hospitalization; cardiac‐resynchronization therapy; cardiovascular hospitalization; heart failure; implantable cardioverter defibrillators; remote monitoring; risk prediction.

Figure 1. Example profiles for each of the patient categories: high, switcher, and never high.

HFRS indicates Heart Failure Risk Status.

Figure 2. Kaplan‐Meier cumulative incidence curves of a subsequent all‐cause and cardiovascular hospitalization episode following the start of the first date a patient was recorded as being in high risk for the patients who experienced their first high Heart Failure Risk Status during the study (ie, switchers).

All‐cause hospitalizations occurred more frequently within the first 180 days, but cardiovascular events occurred linearly with time.

Figure 3. Kaplan‐Meier cumulative incidence curves for all‐cause hospitalization (ACH), cardiovascular hospitalization, and heart failure hospitalization within the 30 days following the diagnostic evaluation period, stratified by the maximum Heart Failure Risk Status (HFRS) reported in the diagnostic evaluation period.

The high‐risk group had a larger incidence across all types of hospitalization compared with those who were medium or low risk after 7 days.

Figure 4. Visual representation of the relationship between Triage Heart Failure Risk Status (Triage‐HFRS), frequency of transmission, 30‐day heart failure hospitalization (HFH) cost (percentage), and total cost of HFH (£), according to Secondary Uses Services Healthcare Resource Group.