Applications of the Multisensor HeartLogic Heart Failure Monitoring Algorithm During the COVID-19 Global Pandemic.
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ABSTRACT:
SUBMITTER: Egolum UO
PROVIDER: S-EPMC7550056 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundWith the ongoing coronavirus disease 2019 (COVID-19) epidemic, remote monitoring of patients with implanted cardiac devices has become more important than ever, as physical distancing measures have placed limits on in-clinic device monitoring. Remote monitoring alerts, particularly those associated with heart failure trends, have proved useful in guiding care in regard to monitoring fluid status and adjusting heart failure medications.Case summaryThis report describes use of Boston Scientific's HeartLogic algorithm, which is a multisensor device algorithm in implantable cardioverter-defibrillator devices that is proven to be an early predictor of heart failure decompensation by measuring several variables, including respiratory rate, nighttime heart rate, and heart sounds. We present three cases of patients who were actively surveilled by the various HeartLogic device algorithm sensors and were identified to have increasing respiratory rates high enough to trigger a HeartLogic alert prior to a positive COVID-19 diagnosis.DiscussionWe propose that the HeartLogic algorithm and its accompanying individual physiologic sensors demonstrate potential for use in identifying non-heart failure-related decompensation, such as COVID-19-positive diagnoses.
| S-EPMC7896811 | biostudies-literature
Project description:AimsThe utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity.MethodsThe HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1-11), lockdown (weeks 12-20), post-lockdown (weeks 21-29).ResultsImmediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15-2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99-1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64-1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely.ConclusionsDuring the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.
| S-EPMC8772791 | biostudies-literature
Project description:During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.
| S-EPMC9217066 | biostudies-literature
Project description:Background:The coronavirus disease 2019 (COVID-19) pandemic has increased burden on healthcare systems with subsequent reductions in non-emergent hospitalizations and procedures. While there are widespread reports of intentional reductions in elective hospitalizations, trends in urgent or emergent hospitalizations including heart failure (HF) hospitalizations have not been adequately characterized. Methods:We evaluated trends of HF hospitalizations before and during the COVID-19 pandemic at the University of Mississippi Medical Center using electronic health records and discharge database. We also compared HF hospitalization trends during the same time frame in 2019 to account for seasonal variation in HF presentations. Results:Prior to the COVID-19 pandemic in our medical center, a mean of 30 patients per week were admitted with a principal diagnosis of HF. After the first case of COVID-19 was diagnosed in Mississippi, there was a sharp 50% decline in the number of HF hospitalizations that declined even further after a "state of emergency" was declared in Mississippi. Conclusions:Based on observations from a large academic medical center, there has been a significant reduction in the number of patients hospitalized for HF during the COVID-19 pandemic. Further investigation of these trends is warranted to determine the effects of the COVID-19 pandemic on long-term HF outcomes.
| S-EPMC7219367 | biostudies-literature
Project description:The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.
| S-EPMC7217768 | biostudies-literature
Project description:The Covid-19 pandemic affects care for cardiovascular conditions, but data on heart failure (HF) are scarce. This study aims to analyse HF care and in-hospital outcomes during the pandemic in Germany. A total of 9452 HF admissions were studied using claims data of 65 Helios hospitals; 1979 in the study period (13 March 30 April 2020) and 4691 and 2782 in two control periods (13 March to 30 April 2019 and 1 January to 12 March 2020). HF admissions declined compared with both control periods by 29-38%. Cardiac resynchronization therapy was implanted in 0.55% during the study period, 0.32% [odds ratio (OR) 1.66, 95% confidence interval (CI) 0.68-4.04, P = 0.27] in the previous year and 0.43% (OR 1.35, 95% CI 0.64-2.84, P = 0.43) in the same year control. Intensive care treatment was 6.22% during the study period, 4.49% in the previous year (OR 1.46, 95% CI 1.13-1.89, P < 0.01), and 5.27% in the same year control (OR 1.19, 95% CI 0.96-1.49, P = 0.12). Length of hospital stay was 7.0 ± 5.0 days in the study and 7.8 ± 5.6 (P < 0.01) and 7.3 ± 5.1 days (P = 0.07) in the control periods. In-hospital mortality was 7.0% in the study and 5.5% in both control periods (P < 0.05). During the early phase of the Covid-19 pandemic in Germany, HF treatment pathways seem not to be affected, but hospital stay shortened and in-hospital mortality increased. As the pandemic continues, this early signal demands close monitoring and further investigation of potential causes.
| S-EPMC7754920 | biostudies-literature
Project description:Background Excess mortality from cardiovascular disease during the COVID-19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12-hospital health system to examine changes in volume, patient age and comorbidities, treatment (right- and left-heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID-19 pandemic compared with pre-COVID-19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID-19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID-19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST-segment elevation. There were no differences in right-heart catheterization for patients with HF or in left heart catheterization for patients with AMI. In-hospital mortality increased for AMI during COVID-19 (odds ratio [OR], 1.46; 95% CI, 1.21-1.76), particularly among the ST-segment-elevation myocardial infarction subgroup (OR, 2.57; 95% CI, 2.24-2.96), but was unchanged for HF (OR, 1.02; 95% CI, 0.89-1.16). Conclusions Cardiovascular volume decreased during COVID-19. Despite similar patient age and comorbidities and in-hospital treatments during COVID-19, mortality increased for patients with AMI but not patients with HF. Given that AMI is a time-sensitive condition, delay or deferral of care rather than changes in hospital care delivery may have led to worse cardiovascular outcomes during COVID-19.
| S-EPMC9075301 | biostudies-literature
Project description:Screening programs have been associated with a substantial reduction in colorectal cancer (CRC) mortality through endoscopic resection of preneoplastic lesions and detection of early-stage invasive cancers.
In March 2020, the World Health Organization declared as a pandemic the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2. Since then, the SARS-CoV-2 have never stopped spreading, causing an unprecedented situation with highly restrictive considerations to be adopted by the majority of countries worldwide.
Health-care facilities have been making an enormous effort to assist patients affected by COVID-19, while adopting measures to maintain a safe environment for patients and healthcare professionals. As a result, the usual workflow in endoscopy departments changed dramatically, leading to an increase in cancelled procedures, probably increasing the future burden of Colorectal Cancer due to delays in diagnosis.
| 2358399 | ecrin-mdr-crc
Project description: Not available
| S-BSST1055 | biostudies-other
Project description:BackgroundDecompensated heart failure (HF) is associated with poor short- and long-term prognosis. Remote invasive monitoring of pulmonary artery pressures (PAP) enables early detection of HF decompensation, before symptoms occur, and may improve clinical outcomes. We aimed to describe our initial experience with the use of the CardioMEMS™ remote monitoring system in patients with HF, including its safety and effectiveness.Methods and resultsFive patients with HF in New York Heart Association class III and at least one hospitalization due to decompensated HF in last 12 months, who underwent invasive remote monitoring of PAP, were included in this prospective registry. The median age was 66.0 years (interquartile range [IQR] 50.5-77.5 years), 80.0% were men and all had HF with reduced ejection fraction. The pulmonary artery (PA) sensor was placed in a left PA branch in all patients and no major procedural complications occurred. In median follow-up of 40 days (IQR 40-61 days), a total of 271 pressure readings were transmitted, patient compliance was 100% and freedom from sensor failure 98.1%. In three patients, PAP remained within the goal during follow-up. Two patients presented an increase in PAP to values above the targets, despite the absence of symptoms worsening. These required dietary and diuretic dose adjustment, without the need for outpatient clinic visits, which reduced PAP. No hospitalizations for HF or deaths occurred during follow-up.ConclusionHemodynamic-guided HF monitoring was safe and effective and may be a useful adjunctive tool to the standard-of-care management in selected HF patients, particularly in the context of the COVID-19 pandemic, where a reduction in the number of health care visits may be desirable.
| S-EPMC8606264 | biostudies-literature