Efficacy and Safety of ICD Remote Monitored Exercise Testing to Improve Heart Failure Outcomes: REMOTE HF-ACTION

Study Overview
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Brief Summary
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This single center randomized controlled trial will involve 50 medically stable outpatients with HF, reduced ejection fraction, and previously implanted ICD or CRT-D devices followed longitudinally on the Abbott Medical Merlin remote patient monitoring network. Patients will be randomized in a 1:1 fashion to usual care plus a remotely administered home based weekly prescription for aerobic exercise (intervention) or usual care alone (control). Usual care will include regularly scheduled visits with the clinical heart failure care team and medical therapy as prescribed by that team. The exercise prescription will be created by an exercise physiologist after incorporating remotely collected data from a patient directed smartphone app assessing HF symptom severity, vital signs, weight, and blood sugar, implantable device measures of physical activity, heart rate, heart failure volume status and heart rhythm, and Fitbit measures of physical activity.

Official Title
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Efficacy and Safety of ICD Remote Monitored Exercise Testing to Improve Heart Failure Outcomes: REMOTE HF-ACTION (Pilot Randomized Controlled Trial)

Conditions
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Heart Failure

Intervention / Treatment
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* Behavioral: Remote Cardiac Rehabilitation (CR)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients have a MERLIN patient registry record for an ICD or CRT-D implantation between 01/01/2010-12/31/2020 Age > 18 years Left ventricular ejection fraction < 50% by echocardiogram, nuclear cardiology scan, cardiac magnetic resonance imaging, or invasive left ventriculography within the past 12 months. Ongoing NYHA class II, III, or IV HF symptoms by questionnaire Ongoing use of beta-blocker and ACE-inhibitor or angiotensin receptor blocker or willingness to start them- assessed by Duke Epic EMR screening. Life expectancy > 12 months To allow for a post-surgical adjustment period, patients must be >30 days out from device implantation Exclusion Criteria: Prior participation in CR- by patient questionnaire Unwillingness to sign informed consent form Currently performing > 240 minutes of device detected daily PA- by ICD/CRTD remotely collected data. Lack of a smartphone or unwillingness to use an App or Fitbit device Prior left ventricular assist device (LVAD) implantation or heart transplantation ICD tachyarrhythmia therapies programmed off Inherited arrhythmia condition with contraindication to exercise (eg Lamin A mutation or ARVC) No transmissions through Merlin.net in past 12 months

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual care<br>Usual care will include regularly scheduled visits with the clinical heart failure care team and medical therapy as prescribed by that team. | |
| Experimental: Remote prescription for aerobic exercise<br>The exercise prescription will be created by an exercise physiologist after incorporating remotely collected data from a patient directed smartphone app assessing HF symptom severity, vital signs, weight, and blood sugar, and cardiac implant measures of physical activity, heart rate, heart failure volume status and heart rhythm, and Fitbit measures of physical activity. | Behavioral: Remote Cardiac Rehabilitation (CR)<br>* Patients randomized to remote CR will be asked to use an app for cardiac rehabilitation a minimum of 3 times a week. Patients will be given an exercise prescription provided by a certified exercise physiologist. The exercise prescription will change each week based on refreshed data from the prior week. Instructional videos for each exercise are provided in the app. Patients will not be told to perform the exercise at a particular time. Instead they will be asked to complete a certain amount of exercise per week at whatever time is convenient for them. Patients randomized to remote CR will also receive App based reminders to take their medications, resources to guide healthy eating habits, and other behavioral health advice as is done as standard of care in both remote based and clinic based CR.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Abbott Implantable Cardioverter-defibrillator (ICD) or Cardiac Resynchronization Therapy Defibrillator (CRT-D) Device Measured Daily Physical Activity (PA) | Reported in minutes of PA per day. | 12 weeks after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Heart Failure (HF) Symptoms Severity Score | The KCCQ has a range of 0 to 100, where a higher score indicates a more favorable health status. | Baseline to 12 weeks | 
| Number of Heart Failure Hospitalization, Fracture, Myocardial Infarction, Serious Adverse Arrhythmia, and ICD Therapy Combination Events |  | Cumulative during 12 weeks of intervention | 
| Kansas City Cardiomyopathy Questionnaire (KCCQ) Heart Failure (HF) Symptom Severity Score | The KCCQ has a range of 0 to 100, where a higher score indicates a more favorable health status. | 12 weeks after randomization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Remote Exercise Prescription, Cardiac Implant