1 Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Italy.
2 Department of Medicine and Surgery, University of Milano-Bicocca, Italy.
J Telemed Telecare. 2017 May;23(4):470-475. doi: 10.1177/1357633X16647633. Epub 2016 Jun 20.
Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728-0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90-7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.
目的
PARTNERS HF 试验制定了一种多参数模型,用于预测心力衰竭患者的急性失代偿,该模型基于定期从心脏再同步化设备下载门诊数据。在这项研究中,我们评估了 PARTNERS HF 标准在远程监测下的中重度心力衰竭患者人群中检测初始失代偿的能力。
方法
我们回顾性地将 PARTNERS HF 标准应用于 104 例患者(中位随访 21 个月,范围 1-67 个月)的 1860 次传输,这些患者在心脏再同步化治疗后参加了我们的远程医疗计划。我们测试了基于这些标准的评分预测在传输后 15 天内任何急性临床失代偿的能力。
结果
在 441 例病例中,在索引传输后诊断为急性心力衰竭。该评分诊断急性失代偿的曲线下面积(AUC)为 0.752(95%置信区间(CI)0.728-0.777)。最佳评分截断值与 PARTNERS HF 的结果一致:评分≥2 时,敏感性为 75%,特异性为 68%。事件的优势比为 6.24(95%CI 4.90-7.95;p<0.001)。
结论
当将 PARTNERS HF 标准回顾性地应用于远程监测传输并排列成评分时,可识别随后发生急性失代偿的心力衰竭患者。这些结果需要前瞻性研究将 PARTNERS HF 标准应用于远程监测。