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Title: | Bioimpedance Alerts from Cardiovascular Implantable Electronic Devices: Observational Study of Diagnostic Relevance and Clinical Outcomes | Authors: | SMEETS, Christophe VRANKEN, Julie Van der Auwera, Jo VERBRUGGE, Frederik MULLENS, Wilfried DUPONT, Matthias GRIETEN, Lars DE CANNIERE, Helene LANSSENS, Dorien VANDENBERK, Thijs STORMS, Valerie THIJS, Inge VANDERVOORT, Pieter |
Issue Date: | 2017 | Publisher: | JMIR PUBLICATIONS, INC | Source: | JOURNAL OF MEDICAL INTERNET RESEARCH, 19(11) (Art N° e393) | Abstract: | Background: The use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices is expanding in the treatment of heart failure. Most of the current devices are equipped with remote monitoring functions, including bioimpedance for fluid status monitoring. The question remains whether bioimpedance measurements positively impact clinical outcome. Objective: The aim of this study was to provide a comprehensive overview of the clinical interventions taken based on remote bioimpedance monitoring alerts and their impact on clinical outcome. Methods: This is a single-center observational study of consecutive ICD and CRT patients (n=282) participating in protocol-driven remote follow-up. Bioimpedance alerts were analyzed with subsequently triggered interventions. Results: A total of 55.0% (155/282) of patients had an ICD or CRT device equipped with a remote bioimpedance algorithm. During 34 (SD 12) months of follow-up, 1751 remote monitoring alarm notifications were received (2.2 per patient-year of follow-up), comprising 2096 unique alerts (2.6 per patient-year of follow-up). Since 591 (28.2%) of all incoming alerts were bioimpedance-related, patients with an ICD or CRT including a bioimpedance algorithm had significantly more alerts (3.4 versus 1.8 alerts per patient-year of follow-up, P<.001). Bioimpedance-only alerts resulted in a phone contact in 91.0% (498/547) of cases, which triggered an actual intervention in 15.9% (87/547) of cases, since in 75.1% (411/547) of cases reenforcing heart failure education sufficed. Overall survival was lower in patients with a cardiovascular implantable electronic device with a bioimpedance algorithm; however, this difference was driven by differences in baseline characteristics (adjusted hazard ratio of 2.118, 95% CI 0.845-5.791). No significant differences between both groups were observed in terms of the number of follow-up visits in the outpatient heart failure clinic, the number of hospital admissions with a primary diagnosis of heart failure, or mean length of hospital stay. Conclusions: Bioimpedance-only alerts constituted a substantial amount of incoming alerts when turned on during remote follow-up and triggered an additional intervention in only 16% of cases since in 75% of cases, providing general heart failure education sufficed. The high frequency of heart failure education that was provided could have contributed to fewer heart failure-related hospitalizations despite significant differences in baseline characteristics. | Notes: | [Smeets, Christophe J. P.; Vranken, Julie; Van der Auwera, Jo; Grieten, Lars; De Canniere, Helene; Lanssens, Dorien; Vandenberk, Thijs; Storms, Valerie; Thijs, Inge M.; Vandervoort, Pieter M.] Hasselt Univ, Fac Med & Life Sci, Mobile Hlth Unit, Hasselt, Belgium. [Smeets, Christophe J. P.; Verbrugge, Frederik H.; Mullens, Wilfried; Dupont, Matthias; De Canniere, Helene; Vandervoort, Pieter M.] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, Genk, Belgium. [Smeets, Christophe J. P.; Vranken, Julie; De Canniere, Helene; Lanssens, Dorien; Vandenberk, Thijs; Thijs, Inge M.; Vandervoort, Pieter M.] Ziekenhuis Oost Limburg, Future Hlth Dept, Genk, Belgium. | Keywords: | defibrillators, implantable; cardiac resynchronization therapy; telemedicine; electric impedance; algorithms; call centers;defibrillators, implantable; cardiac resynchronization therapy; telemedicine; electric impedance; algorithms; call centers | Document URI: | http://hdl.handle.net/1942/26300 | ISSN: | 1438-8871 | DOI: | 10.2196/jmir.8066 | ISI #: | 000416003400001 | Rights: | ©Christophe JP Smeets, Julie Vranken, Jo Van der Auwera, Frederik H Verbrugge, Wilfried Mullens, Matthias Dupont, Lars Grieten, Hélène De Cannière, Dorien Lanssens, Thijs Vandenberk, Valerie Storms, Inge M Thijs, Pieter M Vandervoort. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.11.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2018 |
Appears in Collections: | Research publications |
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