Ellery S, Pakrashi T, Paul V, Sack S
St Peter's Hospital, Guildford Road, Chertsey, Surrey, KT16 0PZ, United Kingdom.
Clin Res Cardiol. 2006;95 Suppl 3:III29-35. doi: 10.1007/s00392-006-1306-6.
The increasing worldwide prevalence of heart failure is associated with numerous and protracted hospital admissions. The multidisciplinary team approach together with telemonitoring aims at reducing the number of rehospitalizations, length of hospital stay, and mortality rates. Novel cardiac resynchronization therapy (CRT) devices have a Home Monitoring capability, offering wireless, everyday transfer of the essential status and therapy data to the attending physician. The transmitted data include potential predictors of death or hospitalization, such as the onset of atrial and ventricular arrhythmias, duration of physical activity, mean heart rates over 24 h and at rest, percentage of CRT delivered, and lead impedances. We present here interim results of the prospective, longitudinal, multicenter Home CARE Phase 0 study, conducted in 123 patients (age: 67+/-9 years, 83% male) with clinical indication for CRT. Twenty-nine patients (24%) received a CRT pacemaker, 52 (42%) a prophylactic implantable cardioverter defibrillator (ICD), and 42 (34%) had other ICD indications. All devices have an integrated Home Monitoring feature. In a mean (interim) follow-up period of 3 months (9194 observational days), 11 unplanned rehospitalizations of cardiovascular etiology and 9 deaths occurred. In 70% of the rehospitalization events, the retrospective analysis of transmitted data via Home Monitoring revealed an increase in mean heart rate at rest and in mean heart rate over 24 h within 7 days preceding hospitalization. A decrease in the percentage of CRT was observed in 43% and a reduction in the patients' daily activity in 30% of rehospitalized patients. These interim findings suggest that Home Monitoring data may predict events leading to hospitalization and encourage further research.
心力衰竭在全球范围内的患病率不断上升，这与大量且持续的住院治疗相关。多学科团队协作加上远程监测旨在减少再次住院次数、缩短住院时间并降低死亡率。新型心脏再同步治疗（CRT）设备具备家庭监测功能，可每天将重要的状态和治疗数据无线传输给主治医生。传输的数据包括死亡或住院的潜在预测因素，如房性和室性心律失常的发作、身体活动时长、24小时及静息时的平均心率、CRT治疗的百分比以及导联阻抗。我们在此展示前瞻性、纵向、多中心家庭护理0期研究的中期结果，该研究纳入了123例有CRT临床指征的患者（年龄：67±9岁，83%为男性）。29例患者（24%）接受了CRT起搏器，52例（42%）接受了预防性植入式心律转复除颤器（ICD），42例（34%）有其他ICD指征。所有设备均具备集成的家庭监测功能。在平均（中期）3个月的随访期（9194个观察日）内，发生了11次心血管病因的非计划再次住院和9例死亡。在70%的再次住院事件中，通过家庭监测对传输数据进行回顾性分析发现，住院前7天内静息时平均心率和24小时平均心率增加。43%的再次住院患者观察到CRT治疗百分比下降，30%的患者日常活动减少。这些中期研究结果表明，家庭监测数据可能预测导致住院的事件，并鼓励进一步研究。
