P323Triage-HF Plus: identification of heart failure and non-heart failure events in an ambulatory population using remote monitoring and the triage heart failure risk score Algorithm
P323Triage-HF Plus: identification of heart failure and non-heart failure events in an ambulatory population using remote monitoring and the triage heart failure risk score Algorithm
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P323Triage-HF Plus：使用远程监测和分诊心力衰竭风险评分算法识别流动人群中的心力衰竭和非心力衰竭事件
DOI：
10.1093/europace/euaa162.071
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Ahmed F
中科院分区：
文献类型：
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作者：
Ahmed F
背景/介绍以前的研究检查了心脏植入式电子装置（CIEDs）用于远程监测心力衰竭患者代偿的效用，并没有显示对硬终点的影响。然而，这些先前的研究（REM-HF和MORE-CARE）的一个关键限制是未能在随机化之前根据患者恶化心力衰竭（WHF）的风险对患者进行分层（常规护理与主动监测）。我们研究了一种不同的方法，使用单一制造商的远程监测平台，仅与cied衍生数据表明WHF风险最高的患者联系以进行评估。经过验证的“分诊心力衰竭风险评分”（Triage- hfrs）是美敦力CIEDs内部的一种医疗算法，可以根据对生理参数的综合监测，将患者在未来30天内的心力衰竭风险分为低、中、高风险。目的：本研究是对分诊- hfrs进行的最大的前瞻性评估，并探讨了通过电话联系具有“高风险”分诊- hfrs警报的患者（分诊- hf Plus途径）的额外作用。方法：2016年6月至2019年9月对Triage-HF Plus通路进行前瞻性、现实评估。联系了326例高危分诊-出血热传播病例，进行电话分诊评估。筛选问题旨在确定WHF和非心力衰竭事件的发作。干预措施由临床医生自行决定，并与指导方针一致。另外，还联系了连续3个月的中低分诊- hfrs传播样本（对照组）进行电话分诊评估（n= 98）。结果在245例高危分类- hfrs警报后，成功进行了电话联系。接触后，194例（79.1%）患者报告了急性医疗问题：137例（70.6%）报告了与心衰（WHF）恶化相一致的症状，需要干预；57人（29.4%）有其他急性医疗问题。51名（26.2%）没有明显原因。基于cied的远程监测识别需要干预的HF和非HF事件的敏感性和特异性分别为99.5%（97.2-99.9%）和65.5% (57.3-73.2%)；阳性预测值为79.2%。非高危评分排除急性事件的阴性预测值为98.9%。该途径识别急性问题（HF或非HF相关）的总体准确性为84.8%。结论Triage-HF Plus临床路径是一种潜在的心衰患者远程监护工具。该途径在识别WHF患者和广泛的非hf问题方面具有很高的诊断准确性，这些问题与经常有多种复杂合并症的人群同样相关，并且以其高医疗利用率而闻名。
Background/introductionPrevious studies examining the utility of cardiac implantable electronic devices (CIEDs) to remotely monitor heart failure patients for decompensation have not demonstrated an impact on hard end-points. However, a key limitation of these prior studies (REM-HF and MORE-CARE) has been the failure to stratify patients according to their risk of worsening heart failure (WHF) prior to randomization (usual care vs active monitoring). We examined a different approach, using a single manufacturer’s remote monitoring platform, whereby only patients with CIED-derived data indicating the highest risk of WHF are contacted for assessment. The validated ‘Triage Heart Failure Risk Score’ (Triage-HFRS) is a medical algorithm within Medtronic CIEDs that can risk-stratify patients as low-, medium- or high-risk of WHF in the next 30 days based on integrated monitoring of physiological parameters.PurposeThis study is the largest prospective evaluation of the Triage-HFRS, and examines the additional role of contacting those patients with a ‘High-Risk’ Triage-HFRS alert by telephone (Triage-HF Plus pathway).MethodsProspective, real-world evaluation of the Triage-HF Plus pathway undertaken between June 2016 and September 2019. 326 high-risk Triage-HFRS transmissions were contacted for telephone triage assessment. Screening questions were designed to identify episodes of WHF and non-heart failure events. Interventions were at the discretion of the clinical practitioner and in line with guideline-directed practice. An additional 3-month consecutive sample of low and medium Triage-HFRS transmissions (control group) were also contacted for telephone triage assessment (n= 98).ResultsSuccessful telephone contact was made following 245 high-risk Triage-HFRS alerts. Following contact, 194 (79.1%) patients reported an acute medical issue: 137 (70.6%) reported symptoms consistent with worsening heart failure (WHF) requiring intervention; and 57 (29.4%) had an alternative acute medical problem. 51 (26.2%) had no apparent reason for the high score. The sensitivity and specificity of CIED-based remote monitoring to identify any HF and non-HF events requiring intervention was 99.5% (97.2-99.9%) and 65.5% (57.3-73.2%) respectively; positive predictive value was 79.2%. The negative predictive value of a non-high risk score to rule out an acute event was 98.9%. Overall accuracy of the pathway to identify an acute issue (HF or non-HF related) was 84.8%.ConclusionThe Triage-HF Plus clinical pathway is a potentially useful remote monitoring tool for patients with heart failure. The pathway has high diagnostic accuracy to identify patients with WHF and a wide range of non-HF issues which are just as relevant in a population who often have multiple complex co-morbidities and are known for their high health care utilisation.