Canadian Journal of Cardiology


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      Remote monitoring programs for heart failure (HF) patients have been designed to identify changes in clinical status and notify clinicians of patient-reported symptoms to detect impending decompensation with a view to intervening before hospitalization is required. A nurse-led, mobile app-based system, Medly, has shown improvement in quality of life (QoL), reduction in HF-related length of stay and biomarkers (Ware et al, 2020). This platform has been routinely used at our institution since 2016 as the local standard of care for remote monitoring. In the MultiSENSE study, implantable electronic devices (Boston Scientific) with special physiological sensors that generated a HeartLogic™ index predicted impending HF decompensation days to weeks before changes occur to weight or clinical symptoms (Boehmer et al 2017). Herein we describe our initial experience using data from HeartLogic™-enabled devices in the addition to our remote monitoring platform.


      In a large HF Clinic based at a quaternary academic cardiac center in Toronto, Ontario, between July 2020 and May 2021, patients monitored remotely through Medly were screened for HeartLogic™ enabled ICD or CRT. They were approached to consent to enhanced monitoring by activating the device sensor and provided with a remote communicator for daily transmissions. They were encouraged to continue to use Medly as usual. A multidisciplinary group: HF Cardiologist, Electrophysiologist, HF Nurse Practitioner, and Medly Nurse met at weekly intervals to review remote monitoring data from Medly and implanted devices. Abnormal findings were shared with the patient's Cardiologist prior to making recommendations on the patient's further management. Results: Twenty-eight patients were enrolled from August 2020 onwards. Of the 28, 11 lived over one hour's distance away from the clinic, 5 ∼1 hour away, the rest lived less than 1 hour away. The median length of monitoring time was 3.25 months. There were 368 Medly alerts and 12 HeartLogic™ alerts, 11 of these alerts were congruent with Medly, one was not but was still clinically relevant. There were 10 therapeutic interventions after review of the HeartLogic™ alerts primarily involving medication adjustments. There were 5 hospitalizations in this cohort, none for HF.


      The use of implantable technologies with physiological sensors is feasible and can complement existing remote monitoring programs. The combination of data, physiologic and patient-reported and multi-disciplinary review can facilitate providing more equitable HF care across the province particularly to those living in remote settings.
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