Triage-HF Validation in Heart Failure Clinical Practice: Importance of Episode Duration

Abstract

Introduction: The prevention of heart failure (HF) exacerbation is crucial for patient prognosis, and preventive treatment for potential symptoms and warning signs is essential in this context. The TriageHF © algorithm has been retrospectively validated and has demonstrated good correlation with HF episodes. This study analyzes the effectiveness of the TriageHF © algorithm in routine clinical practice, emphasizing the role of episode duration in its predictive capacity. Materials and methods: From October 2017 to October 2020, all patients who received a Medtronic Amplia DR implant were prospectively selected for analysis. To evaluate the algorithm's diagnostic capacity, it was compared with the clinical diagnosis of HF episodes during follow-up. Results: The sustained moderate-risk (more than 7 days) and high-risk alerts both showed high positive predictive values (11.25% and 27.27%, respectively), along with an increase in the relative risk of HF, particularly in high-risk alerts (hazard ratio is 46.21 times higher than for sustained moderate-risk alerts). Furthermore, there was higher event-free survival in real low-risk alerts than in both sustained medium-risk and high-risk alerts (p < 0.01). Conclusions: TriageHF © can predict the worsening of patients with ICD CRT. Medium-risk alerts lasting less than 7 days do not pose a greater risk of HF episodes, while high-risk alerts, regardless of their duration, are highly correlated with HF episodes.

Keywords: Amplia DR; TriageHF; algorithm; heart failure; implantable cardiac defibrillators; prediction.

Figure 1

Alert flowchart with clinical events for each risk alert.

Figure 2

Analysis of 30-day survival comparing different Triage-HF alerts. Alerts are categorized as high risk, sustained medium risk, or low risk based on the criteria described in the text * p < 0.01.