Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Salud y Deporte, Universidad Europea de Madrid, Madrid, Spain.
Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Rev Esp Cardiol (Engl Ed). 2024 Dec;77(12):1008-1017. doi: 10.1016/j.rec.2024.04.006. Epub 2024 May 1.
The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts.
The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol.
We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001).
A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.
多参数植入式心脏复律除颤器 HeartLogic 指数已被证明是心力衰竭（HF）失代偿即将发生的敏感且及时的预测指标。我们评估了基于护理人员远程管理警报的标准化随访方案实施的影响。
该算法在 19 个西班牙中心的 HF 患者中激活。远程分析传输数据，如果发出警报，通过电话联系患者。远程或通过门诊就诊实施临床操作。主要终点包括 HF 住院或死亡。次要终点为 HF 门诊就诊。我们比较了采用该方案前后的 12 个月。
我们分析了 392 名（年龄 69±10 岁，76%男性，50%缺血性心肌病）植入式心脏复律除颤器（20%）或心脏再同步治疗除颤器（80%）的患者。主要终点在采用该方案前的 12 个月内，86 名（22%）患者中发生 151 次，采用该方案后的 12 个月内，45 名（11%）患者中发生 69 次（P<.001）。采用该方案前，每位患者的平均住院次数为 0.39±0.89 次，采用该方案后为 0.18±0.57 次（P<.001）。采用该方案前，96 名（24%）患者有 185 次 HF 门诊就诊，采用该方案后，48 名（12%）患者有 64 次（P<.001）。采用该方案前，每位患者的平均就诊次数为 0.47±1.11 次，采用该方案后为 0.16±0.51 次（P<.001）。
基于 HeartLogic 警报远程管理的标准化随访方案实现了 HF 患者的有效远程管理。采用该方案后，HF 住院和门诊就诊显著减少。
