Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester Academic Health Science Centre Manchester United Kingdom.
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health University of Manchester United Kingdom.
J Am Heart Assoc. 2022 Aug 16;11(16):e024526. doi: 10.1161/JAHA.121.024526. Epub 2022 Aug 9.
Background Unplanned hospitalizations are common in patients with cardiovascular disease. The "Triage Heart Failure Risk Status" (Triage-HFRS) algorithm in patients with cardiac implantable electronic devices uses data from up to 9 device-derived physiological parameters to stratify patients as low/medium/high risk of 30-day heart failure (HF) hospitalization, but its use to predict all-cause hospitalization has not been explored. We examined the association between Triage-HFRS and risk of all-cause, cardiovascular, or HF hospitalization. Methods and Results A prospective observational study of 435 adults (including patients with and without HF) with a Medtronic Triage-HFRS-enabled cardiac implantable electronic device (cardiac resynchronization therapy device, implantable cardioverter-defibrillator, or pacemaker). Cox proportional hazards models explored association between Triage-HFRS and time to hospitalization; a frailty term at the patient level accounted for repeated measures. A total of 274 of 435 patients (63.0%) transmitted ≥1 high HFRS transmission before or during the study period. The remaining 161 patients never transmitted a high HFRS. A total of 153 (32.9%) patients had ≥1 unplanned hospitalization during the study period, totaling 356 nonelective hospitalizations. A high HFRS conferred a 37.3% sensitivity and an 86.2% specificity for 30-day all-cause hospitalization; and for HF hospitalizations, these numbers were 62.5% and 85.6%, respectively. Compared with a low Triage-HFRS, a high HFRS conferred a 4.2 relative risk of 30-day all-cause hospitalization (8.5% versus 2.0%), a 5.0 relative risk of 30-day cardiovascular hospitalization (3.6% versus 0.7%), and a 7.7 relative risk of 30-day HF hospitalization (2.0% versus 0.3%). Conclusions In patients with cardiac implantable electronic devices, remotely monitored Triage-HFRS data discriminated between patients at high and low risk of all-cause hospitalization (cardiovascular or noncardiovascular) in real time.
在心血管疾病患者中，计划外住院很常见。心脏植入式电子设备的“分诊心力衰竭风险状况”（Triage-HFRS）算法利用多达 9 个设备衍生的生理参数数据对患者进行分层，低/中/高 30 天心力衰竭（HF）住院风险，但尚未探讨其用于预测全因住院的能力。我们研究了 Triage-HFRS 与全因、心血管或 HF 住院风险之间的关联。
对 435 名接受美敦力 Triage-HFRS 心脏植入式电子设备（心脏再同步治疗设备、植入式心脏复律除颤器或起搏器）治疗的成年人（包括有和没有 HF 的患者）进行前瞻性观察研究。Cox 比例风险模型探讨了 Triage-HFRS 与住院时间之间的关联；患者水平的脆弱性项考虑了重复测量。在研究期间，435 名患者中有 274 名（63.0%）至少传输了 1 次高 HFRS 传输。其余 161 名患者从未传输过高 HFRS。在研究期间，共有 153 名（32.9%）患者发生了≥1 次计划外住院，共发生了 356 次非选择性住院。高 HFRS 对 30 天全因住院的敏感性为 37.3%，特异性为 86.2%；对于 HF 住院，这些数字分别为 62.5%和 85.6%。与低 Triage-HFRS 相比，高 HFRS 使 30 天全因住院的相对风险增加了 4.2（8.5%对 2.0%），使 30 天心血管住院的相对风险增加了 5.0（3.6%对 0.7%），使 30 天 HF 住院的相对风险增加了 7.7（2.0%对 0.3%）。
在心脏植入式电子设备患者中，远程监测的 Triage-HFRS 数据实时区分了高风险和低风险（心血管或非心血管）全因住院患者。
