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Identifying patients (pts) at the risk of heart failure hospitalizations (HFHs) remains a challenge. We show that existing diagnostic flags in an implantable device can stratify pts at varying risk of HFH.
CRT-D data from 746 pts (age: 69±11 yrs, 68% male) followed for 13±5 months with adjudicated HFHs were used. The device variables and corresponding observational flags were as follows: Activity: Mean activity < 1 hr/day for at least 1 week; Night Heart Rate: >85 bpm for all of the most recent 7 days; AT/AF Burden: ≥ 6 hrs for at least 1 day; AT/AF + V-rate: ≥ 6 hrs and Mean V-rate > 100 bpm for at least 1 day; CRT Pacing: < 90% since last device session; VT/VF shocks: At least 1 shock; Impedance (Z) Index: 60 ohm-days. Analysis was also performed by excluding Z. HF risk was assessed at the time of a device interrogation session, and all data until the previous device session were used to determine the risk for next 30 days. 1893 follow-up sessions were evaluated with 37 HFHs in 34 pts.
Percentage of evaluations that were followed by an HFH in the next 30-days increased with number of flags (see Table). Pts with 3 or more flags were at 41 times higher risk of HFH compared to pts with no flag. Even after excluding Z, device parameters effectively stratified pts at the risk of HFH.
Risk of HFH increases with number of observational flags since previous device follow-up. Thus, we present a simple scheme using existing and approved device diagnostic flags that can be used to triage HF pts at the risk of HFH.
|Number of diagnostic observations||Diagnostic observations (including impedance)||Diagnostic observations (excluding impedance)|
|#HFH (%)||GEE adjusted (%) (95% CI)||# HFH (%)||GEE adjusted (%) (95% CI)|
|0||3 (0.3%)||0.3 (0.1–1.0)||13 (1.0%)||1.0 (0.5–1.8)|
|1||14 (2.0%)||2.0 (1.1–3.5)||15 (3.4%)||3.4 (2.0–5.5)|
|2||13 (5.7%)||5.6 (3.3–9.4)||7 (8.5%)||8.5 (4.1–16.6)|
|≥3||7 (12.3%)||12.2 (5.8–24.0)||2 (9.1%)||8.6 (2.5–25.9)|
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Insights into Cardiac Resynchronization and Device Therapies in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1219M-270
- 2013 American College of Cardiology Foundation