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 .
Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure.
AIMS To evaluate the utility of intrathoracic impedance monitoring for detecting  heart failure ( HF ) deterioration in patients with an implanted cardiac resynchronization/defibrillation device . METHODS AND RESULTS Patients enrolled in the European InSync Sentry Observational Study were audibly alerted by a device algorithm if a decrease in intrathoracic impedance suggested fluid accumulation . Clinical HF status and device data were assessed at enrolment , during regular follow-up , and if patients presented with an alert or HF deterioration .  Data from 373 subjects were analysed . Fifty-three alert events and a total of 53 clinical events ( HF deterioration defined by worsening of HF signs and symptoms ) were reported during a median of 4.2 months . Adjusted for multiple events per patient , the alert detected clinical HF deterioration with 60 % sensitivity ( 95 % CI 46 - 73 ) and with a positive predictive value of 60 % ( 95 % CI 46 - 73 ) . Higher NYHA class at baseline was predictive for adequate alert events during follow-up ( P < 0.05 ) . In 11 of 20 HF deteriorations without preceding alert , an upstroke of the fluid index occurred without reaching the programmed alert threshold . CONCLUSION A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration . Future r and omized , controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device
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 .