Impact of remote monitoring in heart failure patients with cardiac implantable electronic devices during COVID-19 pandemic: a single center experience

Background Coronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions. Methods Patients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups. Results No significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672). In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients. Conclusions Specified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.

Automated summary

This study compared the clinical outcomes of heart failure patients with implanted cardiac devices in a remote monitored group and a conventionally followed group during the COVID-19 pandemic. The results showed that patients in the remote monitored group had relatively stable worsening of heart failure, lower elevation of N terminal-pro BNP levels, and lower hospitalization rates for worsening heart failure compared to the conventionally followed group. The specified remote monitoring alert-based detection algorithm may indicate early worsening of heart failure status and prevent heart failure hospitalizations.