Skip to main content

Advertisement

Log in

Remote Physiologic Monitoring for Heart Failure

  • Heart Failure (HJ Eisen, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review will describe the process of remote monitoring in the treatment of heart failure and the clinical trials for different modalities of data collection.

Recent Findings

Small studies monitoring weights, sometimes with other parameters, suggested a significant outcome benefit in meta-analysis. However, this has not been seen in larger studies. Clinical trials of remote monitoring using hemodynamic parameters seems to lead to improved outcomes, with more studies underway. Recently, multi-parameter methods with wearable or implantable devices have shown promise in detecting heart failure. The impact on clinical outcomes is being assessed.

Summary

When using parameters such as daily weights, remote monitoring for heart failure has not been demonstrated to be broadly beneficial, while remote monitoring of hemodynamic parameters to guide heart failure therapy has met with initial success. Methods of combining multiple physiologic measurements appear to accurately detect worsening heart failure, and clinical trials are underway to assess the impact.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jackson SL, Tong X, King RJ, Loustalot F, Hong Y, Ritchey MD. National Burden of heart failure events in the United States, 2006 to 2014. Circ Heart Fail. 2018;11(12):e004873. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004873.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: An update of the 2013 ACCF/AHA guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. Circulation. 2016;134(13):e282–93. https://doi.org/10.1161/CIR.0000000000000435.

    Article  PubMed  Google Scholar 

  3. Desai AS, Stevenson LW. Connecting the circle from home to heart-failure disease management. N Engl J Med. 2010;363(24):2364–7. https://doi.org/10.1056/NEJMe1011769.

    Article  CAS  PubMed  Google Scholar 

  4. Klersy C, De Silvestri A, Gabutti G, Regoli F, Auricchio A. A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol. 2009;54(18):1683–94. https://doi.org/10.1016/j.jacc.2009.08.017.

    Article  PubMed  Google Scholar 

  5. Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JG. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2011;6:CD007228. https://doi.org/10.1002/14651858.CD007228.pub2.

    Article  Google Scholar 

  6. Chaudhry SI, Mattera JA, Curtis JP, Spertus JA, Herrin J, Lin Z, et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010;363(24):2301–9. https://doi.org/10.1056/NEJMoa1010029.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. • Yun JE, Park JE, Park HY, Lee HY, Park DA. Comparative effectiveness of telemonitoring versus usual care for heart failure: a systematic review and meta-analysis. J Card Fail. 2018;24(1):19–28. https://doi.org/10.1016/j.cardfail.2017.09.006This is the most recent meta-analysis of telemonitoring versus usual care for heart failure. Despite several large clinical trials producing neutral results, there still appears to be a signal for benefit, driven mainly by smaller clinical trials.

    Article  PubMed  Google Scholar 

  8. Yu CM, Wang L, Chau E, Chan RH, Kong SL, Tang MO, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005;112(6):841–8. https://doi.org/10.1161/CIRCULATIONAHA.104.492207.

    Article  PubMed  Google Scholar 

  9. Bohm M, Drexler H, Oswald H, Rybak K, Bosch R, Butter C, et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J. 2016;37(41):3154–63. https://doi.org/10.1093/eurheartj/ehw099.

    Article  PubMed  Google Scholar 

  10. Domenichini G, Rahneva T, Diab IG, Dhillon OS, Campbell NG, Finlay MC, et al. The lung impedance monitoring in treatment of chronic heart failure (the LIMIT-CHF study). Europace. 2016;18(3):428–35. https://doi.org/10.1093/europace/euv293.

    Article  PubMed  Google Scholar 

  11. Conraads VM, Tavazzi L, Santini M, Oliva F, Gerritse B, Yu CM, et al. Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J. 2011;32(18):2266–73. https://doi.org/10.1093/eurheartj/ehr050.

    Article  PubMed  Google Scholar 

  12. Heist EK, Herre JM, Binkley PF, Van Bakel AB, Porterfield JG, Porterfield LM, et al. Analysis of different device-based intrathoracic impedance vectors for detection of heart failure events (from the detect fluid early from intrathoracic impedance monitoring study). Am J Cardiol. 2014;114(8):1249–56. https://doi.org/10.1016/j.amjcard.2014.07.048.

    Article  PubMed  Google Scholar 

  13. van Veldhuisen DJ, Braunschweig F, Conraads V, Ford I, Cowie MR, Jondeau G, et al. Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation. 2011;124(16):1719–26. https://doi.org/10.1161/CIRCULATIONAHA.111.043042.

    Article  PubMed  Google Scholar 

  14. Adamson PB, Magalski A, Braunschweig F, Bohm M, Reynolds D, Steinhaus D, et al. Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol. 2003;41(4):565–71. https://doi.org/10.1016/s0735-1097(02)02896-6.

    Article  PubMed  Google Scholar 

  15. Bourge RC, Abraham WT, Adamson PB, Aaron MF, Aranda JM Jr, Magalski A, et al. Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study. J Am Coll Cardiol. 2008;51(11):1073–9. https://doi.org/10.1016/j.jacc.2007.10.061.

    Article  PubMed  Google Scholar 

  16. Abraham WT, Adamson PB, Bourge RC, Aaron MF, Costanzo MR, Stevenson LW, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011;377(9766):658–66. https://doi.org/10.1016/S0140-6736(11)60101-3.

    Article  PubMed  Google Scholar 

  17. Abraham WT, Stevenson LW, Bourge RC, Lindenfeld JA, Bauman JG, Adamson PB. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet. 2016;387(10017):453–61. https://doi.org/10.1016/S0140-6736(15)00723-0.

    Article  PubMed  Google Scholar 

  18. Maurer MS, Adamson PB, Costanzo MR, Eigler N, Gilbert J, Gold MR, et al. Rationale and Design of the Left Atrial Pressure Monitoring to optimize heart failure therapy study (LAPTOP-HF). J Card Fail. 2015;21(6):479–88. https://doi.org/10.1016/j.cardfail.2015.04.012.

    Article  PubMed  Google Scholar 

  19. Abraham WT, Perl L. Implantable hemodynamic monitoring for heart failure patients. J Am Coll Cardiol. 2017;70(3):389–98. https://doi.org/10.1016/j.jacc.2017.05.052.

    Article  PubMed  Google Scholar 

  20. Abraham WT, Adamson PB, Costanzo MR, Eigler N, Gold M, Klapholz M, et al. Hemodynamic monitoring in advanced heart failure: results from the LAPTOP-HF trial. J Card Fail. 2016;22(11):940.

    Article  Google Scholar 

  21. • Adamson PB, Ginn G, Anker SD, Bourge RC, Abraham WT. Remote haemodynamic-guided care for patients with chronic heart failure: a meta-analysis of completed trials. Eur J Heart Fail. 2017;19(3):426–33. https://doi.org/10.1002/ejhf.638This is a meta-analysis of five clinical trials using hemodynamic data collected remotely to guide heart failure treatment. There appears to be a relatively robust signal for benefit in terms of heart failure hospitalization.

    Article  PubMed  Google Scholar 

  22. Lindenfeld J, Abraham WT, Maisel A, Zile M, Smart F, Costanzo MR, et al. Hemodynamic-GUIDEd management of heart failure (GUIDE-HF). Am Heart J. 2019;214:18–27. https://doi.org/10.1016/j.ahj.2019.04.014.

    Article  PubMed  Google Scholar 

  23. Angermann CE, Assmus B, Anker SD, Brachmann J, Ertl G, Kohler F, et al. Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol. 2018;107(11):991–1002. https://doi.org/10.1007/s00392-018-1281-8.

    Article  PubMed  Google Scholar 

  24. Morgan JM, Kitt S, Gill J, McComb JM, Ng GA, Raftery J, et al. Remote management of heart failure using implantable electronic devices. Eur Heart J. 2017;38(30):2352–60. https://doi.org/10.1093/eurheartj/ehx227.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Boriani G, Da Costa A, Quesada A, Ricci RP, Favale S, Boscolo G, et al. Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial. Eur J Heart Fail. 2017;19(3):416–25. https://doi.org/10.1002/ejhf.626.

    Article  PubMed  Google Scholar 

  26. Hindricks G, Taborsky M, Glikson M, Heinrich U, Schumacher B, Katz A, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384(9943):583–90. https://doi.org/10.1016/S0140-6736(14)61176-4.

    Article  PubMed  Google Scholar 

  27. Landolina M, Perego GB, Lunati M, Curnis A, Guenzati G, Vicentini A, et al. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation. 2012;125(24):2985–92. https://doi.org/10.1161/CIRCULATIONAHA.111.088971.

    Article  PubMed  Google Scholar 

  28. Anand IS, Greenberg BH, Fogoros RN, Libbus I, Katra RP. Design of the Multi-Sensor Monitoring in congestive heart failure (MUSIC) study: prospective trial to assess the utility of continuous wireless physiologic monitoring in heart failure. J Card Fail. 2011;17(1):11–6. https://doi.org/10.1016/j.cardfail.2010.08.001.

    Article  PubMed  Google Scholar 

  29. Anand IS, Tang WH, Greenberg BH, Chakravarthy N, Libbus I, Katra RP. Design and performance of a multisensor heart failure monitoring algorithm: results from the multisensor monitoring in congestive heart failure (MUSIC) study. J Card Fail. 2012;18(4):289–95. https://doi.org/10.1016/j.cardfail.2012.01.009.

    Article  PubMed  Google Scholar 

  30. • Boehmer J, Wariar R, Zhang Y, Thompson J, Herro G, Sweeney R, et al. Rationale and design of the multisensor chronic evaluations in ambulatory heart failure patients (multisense) study. J Innov Cardiac Rhythm Manag. 2015;6:2137–43 This presents a multisensor method of detecting worsening heart failure with good sensitivity and specificity. It is available now as an alert system and is the subject of study in the MANAGE-HF clinical trial.

    Google Scholar 

  31. Boehmer JP, Hariharan R, Devecchi FG, Smith AL, Molon G, Capucci A, et al. A multisensor algorithm predicts heart failure events in patients with implanted devices: results from the MultiSENSE study. JACC Heart Fail. 2017;5(3):216–25. https://doi.org/10.1016/j.jchf.2016.12.011.

    Article  PubMed  Google Scholar 

  32. Gardner RS, Singh JP, Stancak B, Nair DG, Cao M, Schulze C, et al. HeartLogic multisensor algorithm identifies patients during periods of significantly increased risk of heart failure events: results from the MultiSENSE study. Circ Heart Fail. 2018;11(7):e004669. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004669.

    Article  PubMed  Google Scholar 

  33. Cao M, Gardner RS, Hariharan R, Nair DG, Schulze C, An Q, et al. Ambulatory monitoring of heart sounds via an implanted device is superior to auscultation for prediction of heart failure events. J Card Fail. 2019;26:151–9. https://doi.org/10.1016/j.cardfail.2019.10.006.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John P. Boehmer.

Ethics declarations

Conflict of Interest

Omaima Ali and Alexander G. Hajduczok declare that they have no conflict of interest. John P. Boehmer reports grants and personal fees from Boston Scientific Corp, personal fees from Medtronic, grants from Abbott, during the conduct of the study, and grants and personal fees from Respicardia, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ali, O., Hajduczok, A.G. & Boehmer, J.P. Remote Physiologic Monitoring for Heart Failure. Curr Cardiol Rep 22, 68 (2020). https://doi.org/10.1007/s11886-020-01309-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-020-01309-x

Keywords

Navigation