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 .
Cardiac-resynchronization therapy for the prevention of heart-failure events.
BACKGROUND This trial was design ed to determine whether cardiac-resynchronization therapy ( CRT ) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms , a reduced ejection fraction , and a wide QRS complex . METHODS During a 4.5-year period , we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy , an ejection fraction of 30 % or less , a QRS duration of 130 msec or more , and New York Heart Association class I or II symptoms . Patients were r and omly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator ( ICD ) ( 1089 patients ) or an ICD alone ( 731 patients ) . The primary end point was death from any cause or a nonfatal heart-failure event ( whichever came first ) . Heart-failure events were diagnosed by physicians who were aware of the treatment assignments , but they were adjudicated by a committee that was unaware of assignments . RESULTS During an average follow-up of 2.4 years , the primary end point occurred in 187 of 1089 patients in the CRT-ICD group ( 17.2 % ) and 185 of 731 patients in the ICD-only group ( 25.3 % ) ( hazard ratio in the CRT-ICD group , 0.66 ; 95 % confidence interval [ CI ] , 0.52 to 0.84 ; P=0.001 ) . The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy . The superiority of CRT was driven by a 41 % reduction in the risk of heart-failure events , a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more . CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction . There was no significant difference between the two groups in the overall risk of death , with a 3 % annual mortality rate in each treatment group . Serious adverse events were infrequent in the two groups . CONCLUSIONS CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex . ( Clinical Trials.gov number , NCT00180271 .
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 .