Remote monitoring data from cardiac implantable electronic devices predicts all-cause mortality.
Remote monitoring data from cardiac implantable electronic devices predicts all-cause mortality.
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DOI：
10.1093/europace/euab160
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发表时间：
2022-02-02
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影响因子：
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通讯作者：
Taylor JK
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作者：
Ahmed FZ;Sammut-Powell C;Kwok CS;Tay T;Motwani M;Martin GP;Taylor JK
确定来自心脏植入式电子设备 (CIED) 的远程监测生理数据是否可用于识别高死亡风险的患者。本研究评估了基于 CIED 生理数据的风险评分（分类-心力衰竭风险状态，‘Triage-HFRS’，之前已验证可预测心力衰竭 (HF) 事件）是否可以识别死亡高风险患者。前瞻性招募了 439 名患有 CIED 的成年人。主要观察结果是全因死亡率（中位随访时间：702 天）。 CIED 持续监测多种生理参数（包括心率曲线、心房颤动/心动过速 (AF/AT) 负荷、AT/AF 期间的心室率、体力活动、胸廓阻抗、室性心动过速/颤动治疗），并动态组合以每 24 小时生成一次 Triage-HFRS。根据传播情况，患者被分为“高风险”或“非高风险”组。随访期间，285 名患者（65%）出现高危发作，60 名患者（14%）死亡（高危组 50 名；非高危组 10 名）。在高危组中观察到心血管死亡人数显着增加，高危组与非高危组的死亡率分别为 10.3% 和 <4.0%； P = 0.03。经历任何高风险事件都与死亡风险显着增加相关[比值比 (OR)：3.07，95% 置信区间 (CI)：1.57–6.58，P = 0.002]。此外，每次连续≥14天的高危事件都与死亡几率增加相关（OR：1.26，95% CI：1.06–1.48；P = 0.006）。 CIED 的远程监测数据可用于识别全因死亡和心力衰竭事件风险较高的患者。与其他预后评分不同，这种方法是自动化的并且不断更新。
To determine if remotely monitored physiological data from cardiac implantable electronic devices (CIEDs) can be used to identify patients at high risk of mortality. This study evaluated whether a risk score based on CIED physiological data (Triage-Heart Failure Risk Status, ‘Triage-HFRS’, previously validated to predict heart failure (HF) events) can identify patients at high risk of death. Four hundred and thirty-nine adults with CIEDs were prospectively enrolled. Primary observed outcome was all-cause mortality (median follow-up: 702 days). Several physiological parameters [including heart rate profile, atrial fibrillation/tachycardia (AF/AT) burden, ventricular rate during AT/AF, physical activity, thoracic impedance, therapies for ventricular tachycardia/fibrillation] were continuously monitored by CIEDs and dynamically combined to produce a Triage-HFRS every 24 h. According to transmissions patients were categorized into ‘high-risk’ or ‘never high-risk’ groups. During follow-up, 285 patients (65%) had a high-risk episode and 60 patients (14%) died (50 in high-risk group; 10 in never high-risk group). Significantly more cardiovascular deaths were observed in the high-risk group, with mortality rates across groups of high vs. never-high 10.3% vs. <4.0%; P = 0.03. Experiencing any high-risk episode was associated with a substantially increased risk of death [odds ratio (OR): 3.07, 95% confidence interval (CI): 1.57–6.58, P = 0.002]. Furthermore, each high-risk episode ≥14 consecutive days was associated with increased odds of death (OR: 1.26, 95% CI: 1.06–1.48; P = 0.006). Remote monitoring data from CIEDs can be used to identify patients at higher risk of all-cause mortality as well as HF events. Distinct from other prognostic scores, this approach is automated and continuously updated.