Swipe om te navigeren naar een ander artikel
In the care of heart failure patients, telemonitoring is receiving growing attention. The main purpose of this study was to determine the effect of continuous telemonitoring with an implantable loop recorder (ILR, Reveal XT), a novel strategy in the management of stable heart failure patients without a cardiac implantable device. Furthermore, little is known about the incidence of subclinical arrhythmias in this specific group of patients.
Stable heart failure patients, New York Heart Association Class II and III, without recent hospitalisation or upcoming intervention, were included. After implantation of the ILR there was regular contact with the research nurse on a pre-specified basis. Clinic visits and telephonic interviews were alternated for a minimum of 1 year. Parallel visits to their treating physician continued according to standard care. The treating physician was blinded for the ILR findings, accept for pre-specified, significant arrhythmic events.
Thirty patients were included and followed for a median duration of 12 months. In 13 patients, data from the loop recorder led to therapeutic changes. One patient received a pacemaker. Eight patients developed atrial fibrillation, all subclinical, with a mean burden of 65.8 ± 173.2 min/day.
The use of an ILR could potentially impact patient management. Additional study is needed in different patient populations (e. g. higher risk groups) to assess if an ILR could also impact on endpoints such as heart failure hospitalisation.
McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J. 2012;33:1787–847. CrossRef
Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive hart failure and their joint influence on morality: the Framingham Heart Study. Circulation. 2003;107:2920–5. CrossRef
Asselbergs FW, Baars, F, Boyne, JJJ, et al. Samenwerkingsafspraken en kwaliteitscriteria bij invoeren telebegeleiding bij hartfalen in Nederland. 2016; Retrieved September 12, 2017, from http://www.nvhvv.nl/userfiles/Samenwerkingsafspraken%20en%20kwaliteitscriteria%20bij%20invoeren%20telebegeleiding.pdf
Hasan A, Paul V. Telemonitoring in chronic heart failure. Eur Heart J. 2011;32:1457–64. CrossRef
Hindricks G, Taborsky M, Glikson M, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384:583–90. CrossRef
Black JT, Romano PS, Sadeghi B, et al. A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition—Heart Failure (BEAT-HF) randomized controlled trial. Trials. 2014;15:124. CrossRef
Chaudhry SI, Barton B, Mattera J, et al. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. J Card Fail. 2007;13:709–14. CrossRef
Koehler F, Winkler S, Schieber M, et al. Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Eur J Heart Fail. 2010;12:1354–62. CrossRef
Sardu C, Santamaria M, Rizzo MR, et al. Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART Study. Int J Clin Pract. 2016;70:569–76. CrossRef
Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JGF. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane review. Eur J Heart Fail. 2011;13:1028–40. CrossRef
Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010;363:2301–9. CrossRef
Koehler F, Winkler S, Schieber M, et al. Telemedicine in heart failure: pre-specified and exploratory subgroup analyses from the TIM-HF trial. Int J Cardiol. 2012;161:143–50. CrossRef
Kroenke K, Spitzer RL. The PHQ-9 : a new depression measure. Psychiatr Ann. 2002;32:509–15. CrossRef
Roy D, Talajic M, Dubuc M, et al. Atrial fibrillation and congestive heart failure. Curr Opin Cardiol. 2009;24:29–34. CrossRef
Ziaei F, Zaman M, Rasoul D, et al. The prevalence of atrial fibrillation amongst heart failure patients increases with age. Int J Cardiol. 2016;214:410–1. CrossRef
Boriani G, Glotzer TV, Santini M, et al. Device-detected atrial fibrillation and risk for stroke: an analysis of 〉10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). Eur Heart J. 2014;35:508–16. CrossRef
Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366:120–9. CrossRef
Podd SJ, Sugihara C, Furniss SS, Sulke N. Are implantable cardiac monitors the “gold standard” for atrial fibrillation detection? A prospective randomized trial comparing atrial fibrillation monitoring using implantable cardiac monitors and DDDRP permanent pacemakers in post atrial fibrillation ablation patients. Europace. 2015;18:1000–5. CrossRef
Ponikowski P, Voors AA, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–200. CrossRef
Varma N, Epstein AE, Irimpen A, Schweikert R, Love C, TRUST investigators. Efficay and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up. Circulation. 2010;122:325–32. CrossRef
Crossley GH, Boyle A, Vitense H, Mead CY. The CONNECT (clinical evaluation of remote notification to reduce time to clinical descision) trial: the value of wireless remote monitoring with automatic clinician alerts. J Am Coll Cardiol. 2011;37:1181–9. CrossRef
Boehmer JP, Hariharan R, Devecchi FG, et al. A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices. Jacc Heart Fail. 2017;5:216–25. CrossRef
Telemonitoring with an implantable loop recorder in outpatient heart failure care
One year follow-up report from a prospective observational Dutch multicentre study
R. S. S. Kort
Y. S. Tuininga
H. A. Bosker
- Bohn Stafleu van Loghum