Heart Institute of the Clinical Center University of Pécs, University of Pécs Medical School, Ifjuság Street 13, Pecs, 7621, Hungary.
1st Department of Medicine of Clinical Center University of Pécs, University of Pécs Medical School, Ifjusag ut 13, 7621, Pecs, Hungary.
J Cardiothorac Surg. 2022 Aug 28;17(1):213. doi: 10.1186/s13019-022-01963-y.
Coronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions.
Patients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups.
No significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672). In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients.
Specified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.
2019 年冠状病毒病（COVID-19）已蔓延成全球影响医疗保健提供者的大流行病。尽管大流行相关的医疗保健限制，植入心脏设备的心力衰竭患者仍需要密切随访。
对 61 例远程监测（RMG）和 71 例常规（仅门诊）随访（CFG）的心脏设备植入心力衰竭患者进行回顾性登记，并比较了临床结局。在 COVID-19 大流行相关间歇性机构限制期间，随访时间为 12 个月。我们在 RMG 中使用了指定的心力衰竭检测算法。该研究比较了两组患者的主要终点（心力衰竭恶化、心律失常和设备相关不良事件）和次要终点（心力衰竭住院率）。
在 COVID-19 大流行的前 12 个月，主要复合终点无显著差异（p=0.672）。在 RMG 中，心力衰竭恶化的患者在心力衰竭功能分级方面仅有适度恶化（p=0.026），在门诊评估时 N 末端-pro BNP 水平相对较低（p<0.01），并且在大流行的前 6 个月中因心力衰竭恶化而住院的次数较少（p=0.012）。
针对植入心脏设备的心力衰竭患者的特定远程监测警报驱动的检测算法和工作流程可能可以早期指示心力衰竭状态恶化。预先进行充分的干预可能会阻止心力衰竭恶化的进一步进展，从而预防心力衰竭住院。
