Optimization of heart failure care using cardiac implantable electronic device based remote monitoring

Abstract

The number of heart failure patients progressively increased over the past decades, and heart failure is therefore designated as a global pandemic. Despite pharmacological and technological advances contributing to improved quality of live and survival, the prognosis of heart failure patients still remains poor. To reduce the burden of disease and halt the progression on an individual level, early detection of decompensated heart failure is an easily identifiable target.

Over the last decade, timely detection of fluid retention became feasible with invasive hemodynamic sensors or with multisensory cardiac implantable electronic device (CIED)-based algorithms. During the COVID-19 pandemic, remote monitoring facilitated a pivotal shift and enabled the allocation of healthcare resources to those in most urgent need. Consequently, this thesis endeavors to provide novel insights into enhancing the quality and efficiency of heart failure care through CIED-supported management. This thesis demonstrated that remote monitoring-guided care of heart failure patients with a CIED is feasible, safe and can successfully be implemented in a real-world setting. Furthermore, alert-based remote monitoring allows for timely and individually tailored medical interventions. Robust negative predictive values can guide the transition of care and resources to those who need it the most. Technological advances and the growing number of studies demonstrate beneficial effect on the number of worsening heart failure events resulting in increasingly structurally implemented remote monitoring strategies in regular heart failure care.