Introduction
Heart failure represents an important cause of hospitalization and is associated with an increased cardiovascular risk for the patient as well as an increase in healthcare spending. In recent years, algorithms for detecting pre-heart failure subclinical changes have been developed for implantable defibrillator (ICD) users so as to be able to act early and avoid hospitalization. In our reality we have created a teamwork dedicated to the evaluation of alerts which includes the electrophysiologist, the heart failure cardiologist and the cardiology technician.
Matherial and Methodes
Thirteen patients implanted with Boston Scientific ICDs and CRT-Ds in the period between November 2019 and December 2022 were considered, 9 males and 4 females with an average age of 69.7 years. The object of the study were the Heart-Logic algorithm with a total of 41 alerts received which were followed by telephone contact in an average time of 2.6 days evaluating any ongoing symptoms, adherence to the prescribed therapy and whether there had been any changes to the same, blood pressure trend and any recent laboratory tests. On the basis of this, an outpatient visit was scheduled in 13 cases (31.7%) and the diuretic was increased in 19 cases (46.3%) and the beta-blocker in 6 cases (14.6%); in 4 cases (9.7%) has been modified the SGLT2 dose. In 12 cases (29.2%) no action was taken following telephone contact and among these only 2 hospitalizations occurred. The most represented component of alert activation was the variation in heart tones followed by thoracic impedance and nocturnal heart rate. The average time on alert was 3.4 weeks.
Conclusions
The multiparametric algorithm has shown, also in our experience, good sensitivity but the share of false positives is not negligible, for which we believe as very important the clinical-therapeutic evaluation following receipt of the alert, which must be analyzed in its activation components before therapy adjustments or other decisions. In our organization the Cardiology Technician plays a fundamental role as he receives the alert, quickly calls the patient collecting the information described above and interfaces with the doctor to decide the actions to take. As part of the specific heart failure service for patients with CIEDs, the Technician supports the cardiologist in the management of the patient, providing a fundamental contribution in the evaluation and interpretation of remote transmissions.
