RESULTS Device diagnostics showed strong correlation with established HF biomarkers and hemodynamic measures .
The findings from this review indicate that device diagnostic parameters predict impending HF much earlier than traditional methods of monitoring do .
Device diagnostics are also more accurate in the early prediction of HF when compared with noninvasive objective measures , particularly when multiple parameters are combined and monitored for trends .
Device diagnostics possess a distinct advantage over traditional methods of monitoring for HF because they allow clinicians to remotely monitor the status of their HF patients without relying on patient compliance for data entry and reporting .
Studies regarding the efficacy of device diagnostic parameters suggest that their integration into clinical practice will provide a more accurate and reliable mechanism for assisting clinicians in risk stratifying and predicting potential episodes of decompensated HF
BACKGROUND Traditional methods of heart failure ( HF ) management are based on reactive strategies to treat late indicators of decompensated HF .
Advances in monitoring methods have become available with the evolution of implantable cardioverter-defibrillators and cardiac-resynchronization therapy devices .
These devices provide new diagnostic data and remote monitoring capabilities that allow clinicians to proactively monitor patients for earlier signs of worsening HF .
The integration of data obtained from implantable cardioverter-defibrillator and cardiac-resynchronization therapy technology could improve outpatient HF care , potentially leading to decreased readmission rates and improved patient outcomes .
OBJECTIVE This review will synthesize the literature regarding the efficacy of device diagnostic data and the usability of the data in the clinical setting .
Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure
Background — Heart failure is associated with frequent hospitalizations , often result ing from volume overload . Measurement of intrathoracic impedance with an implanted device with an audible patient alert may detect increases in pulmonary fluid retention early . We hypothesized that early intervention could prevent hospitalizations and affect outcome . Methods and Results — We studied 335 patients with chronic heart failure who had undergone implantation of an implantable cardioverter-defibrillator alone ( 18 % ) or with cardiac resynchronization therapy ( 82 % ) . All devices featured a monitoring tool to track changes in intrathoracic impedance ( OptiVol ) and other diagnostic parameters . Patients were r and omized to have information available to physicians and patients as an audible alert in case of preset threshold crossings ( access arm ) or not ( control arm ) . The primary end point was a composite of all-cause mortality and heart failure hospitalizations . During 14.9±5.4 months , this occurred in 48 patients ( 29 % ) in the access arm and in 33 patients ( 20 % ) in the control arm ( P=0.063 ; hazard ratio , 1.52 ; 95 % confidence interval , 0.97–2.37 ) . This was due mainly to more heart failure hospitalizations ( hazard ratio , 1.79 ; 95 % confidence interval , 1.08–2.95 ; P=0.022 ) , whereas the number of deaths was comparable ( 19 versus 15 ; P=0.54 ) . The number of outpatient visits was higher in the access arm ( 250 versus 84 ; P<0.0001 ) , with relatively more signs of heart failure among control patients during outpatient visits . Although the trial was terminated as a result of slow enrollment , a post hoc futility analysis indicated that a positive result would have been unlikely . Conclusion — Use of an implantable diagnostic tool to measure intrathoracic impedance with an audible patient alert did not improve outcome and increased heart failure hospitalizations and outpatient visits in heart failure patients . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT 00480077
RESULTS Device diagnostics showed strong correlation with established HF biomarkers and hemodynamic measures .
The findings from this review indicate that device diagnostic parameters predict impending HF much earlier than traditional methods of monitoring do .
Device diagnostics are also more accurate in the early prediction of HF when compared with noninvasive objective measures , particularly when multiple parameters are combined and monitored for trends .
Device diagnostics possess a distinct advantage over traditional methods of monitoring for HF because they allow clinicians to remotely monitor the status of their HF patients without relying on patient compliance for data entry and reporting .
Studies regarding the efficacy of device diagnostic parameters suggest that their integration into clinical practice will provide a more accurate and reliable mechanism for assisting clinicians in risk stratifying and predicting potential episodes of decompensated HF
BACKGROUND Traditional methods of heart failure ( HF ) management are based on reactive strategies to treat late indicators of decompensated HF .
Advances in monitoring methods have become available with the evolution of implantable cardioverter-defibrillators and cardiac-resynchronization therapy devices .
These devices provide new diagnostic data and remote monitoring capabilities that allow clinicians to proactively monitor patients for earlier signs of worsening HF .
The integration of data obtained from implantable cardioverter-defibrillator and cardiac-resynchronization therapy technology could improve outpatient HF care , potentially leading to decreased readmission rates and improved patient outcomes .
OBJECTIVE This review will synthesize the literature regarding the efficacy of device diagnostic data and the usability of the data in the clinical setting .