Ahmed Fozia Zahir, Crosbie Carol, Kahn Matthew, Motwani Manish
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Eur Heart J Case Rep. 2020 Sep 9;4(FI1):1-6. doi: 10.1093/ehjcr/ytaa249. eCollection 2020 Oct.
Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic.
An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The 'Triage Heart Failure Risk Score' (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any 'high' Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient's home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner.
The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.
患有心脏植入式电子设备（CIED）的心力衰竭（HF）患者是一个重要群体。他们住院和死亡风险增加。我们概述了如何利用传输的健康相关数据的纯远程管理策略，在2019冠状病毒病大流行期间优化对患有CIED的HF患者的护理。
一名82岁男性，HF病情稳定，接受药物治疗，于2016年接受心脏再同步治疗植入术。现代CIED通过提供实时生理数据（胸段阻抗、心率和心律等）促进远程监测。美敦力CIED上提供的“心力衰竭分诊风险评分”（Triage-HFRS）将多个监测到的生理参数整合到一个风险预测模型中，将患者分类为30天内发生HF事件的低、中或高风险。2019年11月，该患者纳入了一种创新的临床路径（Triage-HF Plus），即任何“高”Triage-HF风险状态传输都会引发基于电话的虚拟会诊。3月11日通过远程传输收到高风险警报，触发电话评估。在报告呼吸急促加重后，开始使用利尿剂。处方通过远程开具并送到患者家中。这种方法避免了所有面对面复诊的需要，以完全远程的方式提供护理。
2019冠状病毒病带来的挑战促使我们重新思考如何为患者提供护理，无论是现在还是在大流行之后。当代CIED通过提供丰富的生理数据促进对HF患者的远程监测，这些数据可以帮助利用设备自动生成的警报识别失代偿风险升高的个体。
