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      Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance

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          Abstract

          Background

          Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation.

          Objective

          In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations.

          Methods

          We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM).

          Results

          Algorithms using NITTI in the 2 weeks preceding decompensation predicted events ( P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines.

          Conclusions

          NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation.

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          Most cited references41

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          Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial.

          Results of previous studies support the hypothesis that implantable haemodynamic monitoring systems might reduce rates of hospitalisation in patients with heart failure. We undertook a single-blind trial to assess this approach. Patients with New York Heart Association (NYHA) class III heart failure, irrespective of the left ventricular ejection fraction, and a previous hospital admission for heart failure were enrolled in 64 centres in the USA. They were randomly assigned by use of a centralised electronic system to management with a wireless implantable haemodynamic monitoring (W-IHM) system (treatment group) or to a control group for at least 6 months. Only patients were masked to their assignment group. In the treatment group, clinicians used daily measurement of pulmonary artery pressures in addition to standard of care versus standard of care alone in the control group. The primary efficacy endpoint was the rate of heart-failure-related hospitalisations at 6 months. The safety endpoints assessed at 6 months were freedom from device-related or system-related complications (DSRC) and freedom from pressure-sensor failures. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. In 6 months, 83 heart-failure-related hospitalisations were reported in the treatment group (n=270) compared with 120 in the control group (n=280; rate 0·31 vs 0·44, hazard ratio [HR] 0·70, 95% CI 0·60-0·84, p<0·0001). During the entire follow-up (mean 15 months [SD 7]), the treatment group had a 39% reduction in heart-failure-related hospitalisation compared with the control group (153 vs 253, HR 0·64, 95% CI 0·55-0·75; p<0·0001). Eight patients had DSRC and overall freedom from DSRC was 98·6% (97·3-99·4) compared with a prespecified performance criterion of 80% (p<0·0001); and overall freedom from pressure-sensor failures was 100% (99·3-100·0). Our results are consistent with, and extend, previous findings by definitively showing a significant and large reduction in hospitalisation for patients with NYHA class III heart failure who were managed with a wireless implantable haemodynamic monitoring system. The addition of information about pulmonary artery pressure to clinical signs and symptoms allows for improved heart failure management. CardioMEMS. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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              Clinical epidemiology of heart failure.

              The aim of this paper is to review the clinical epidemiology of heart failure. The last paper comprehensively addressing the epidemiology of heart failure in Heart appeared in 2000. Despite an increase in manuscripts describing epidemiological aspects of heart failure since the 1990s, additional information is still needed, as indicated by various editorials.
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                Author and article information

                Contributors
                Journal
                JMIR Med Inform
                JMIR Med Inform
                JMI
                JMIR Medical Informatics
                Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                2291-9694
                Jan-Mar 2016
                18 February 2016
                : 4
                : 1
                : e3
                Affiliations
                [1] 1Personal Health Solutions Philips Research EindhovenNetherlands
                [2] 2Department of Electrical Engineering Eindhoven University of Technology EindhovenNetherlands
                [3] 3Department of Health Professional Studies Faculty of Health & Social Care University of Hull Kingston-Upon-HullUnited Kingdom
                [4] 4ACTLab University of Passau PassauGermany
                [5] 5National Heart & Lung Institute Imperial College LondonUnited Kingdom
                Author notes
                Corresponding Author: Illapha Cuba Gyllensten illapha@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-9241-3763
                http://orcid.org/0000-0002-6731-005X
                http://orcid.org/0000-0003-1963-345X
                http://orcid.org/0000-0002-4333-4460
                http://orcid.org/0000-0002-3343-9285
                http://orcid.org/0000-0001-6811-3659
                http://orcid.org/0000-0002-1471-7016
                Article
                v4i1e3
                10.2196/medinform.4842
                4777885
                26892844
                d9ade00c-46a3-4787-a13f-fbbb3348fe26
                ©Illapha Cuba Gyllensten, Alberto G Bonomi, Kevin M Goode, Harald Reiter, Joerg Habetha, Oliver Amft, John GF Cleland. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.02.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.

                History
                : 18 June 2015
                : 29 July 2015
                : 9 September 2015
                : 7 October 2015
                Categories
                Original Paper
                Original Paper

                heart failure,telemonitoring,deterioration detection,alert algorithms,ambulatory monitoring,impedance

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