Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Eur J Intern Med. 2023 Sep;115:1-9. doi: 10.1016/j.ejim.2023.04.011. Epub 2023 Apr 17.
In this review we focus on heart failure (HF) which, as known, is associated with a substantial risk of hospitalizations and adverse cardiovascular outcomes, including death. In recent years, systems to monitor cardiac function and patient parameters have been developed with the aim to detect subclinical pathophysiological changes that precede worsening HF. Several patient-specific parameters can be remotely monitored through cardiac implantable electronic devices (CIED) and can be combined in multiparametric scores predicting patients' risk of worsening HF with good sensitivity and moderate specificity. Early patient management at the time of pre-clinical alerts remotely transmitted by CIEDs to physicians might prevent hospitalizations. However, it is not clear yet which is the best diagnostic pathway for HF patients after a CIED alert, which kind of medications should be changed or escalated, and in which case in-hospital visits or in-hospital admissions are required. Finally, the specific role of healthcare professionals involved in HF patient management under remote monitoring is still matter of definition. We analyzed recent data on multiparametric monitoring of patients with HF through CIEDs. We provided practical insights on how to timely manage CIED alarms with the aim to prevent worsening HF. We also discussed the role of biomarkers and thoracic echo in this context, and potential organizational models including multidisciplinary teams for remote care of HF patients with CIEDs.
在这篇综述中，我们重点关注心力衰竭（HF），众所周知，心力衰竭与住院和不良心血管结局（包括死亡）的风险显著相关。近年来，已经开发出了用于监测心脏功能和患者参数的系统，旨在检测在 HF 恶化之前发生的亚临床病理生理变化。通过心脏植入式电子设备（CIED）可以远程监测多个患者特定参数，并可以结合多种预测患者 HF 恶化风险的参数，具有良好的敏感性和中等特异性。在 CIED 远程传输的临床前警报时及早对患者进行管理，可能会预防住院。然而，目前还不清楚在 CIED 警报后，HF 患者的最佳诊断途径是什么，应该改变或升级哪种药物，以及在何种情况下需要门诊或住院治疗。最后，在远程监测下参与 HF 患者管理的医疗保健专业人员的具体角色仍有待确定。我们分析了最近通过 CIED 对 HF 患者进行多参数监测的数据。我们就如何及时管理 CIED 警报以预防 HF 恶化提供了实用见解。我们还讨论了生物标志物和胸腔超声在这方面的作用，以及包括多学科团队在内的远程护理 HF 患者的潜在组织模型。
