Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2015; 7(12): 922-930
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.922
Comparison of partners-heart failure algorithm vs care alert in remote heart failure management
Leonardo Calo’, Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Giuseppe Giunta, Maria Grazia Romano, Roberto Colaceci, Antonio Ciccaglioni, Fabrizio Ammirati, Ermenegildo de Ruvo
Leonardo Calo’, Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy
Annamaria Martino, Giuseppe Giunta, Antonio Ciccaglioni, Cardiovascular, Respiratory, Nephrologic and Geriatrics Sciences Department, Umberto I Hospital, Sapienza University of Rome, 00185 Rome, Italy
Maria Grazia Romano, Roberto Colaceci, Fabrizio Ammirati, Department of Cardiology, G.B. Grassi Hospital, 00100 Rome, Italy
Author contributions: Calo’ L designed the research; Martino A, Tota C, Fagagnini A, Iulianella R and Rebecchi M performed the research; Calo’ L, Martino A, Tota C, Fagagnini A, Iulianella R, Rebecchi M and Sciarra L analyzed the data; Calo’ L, Martino A, Tota C, Fagagnini A, Iulianella R, Rebecchi M, Sciarra L, Giunta G, Romano MG, Colaceci R, Ciccaglioni A, Ammirati F and de Ruvo E wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Policlinico Casilino, ASL RMB, Rome, Italy.
Informed consent statement: All study participants or their legal guardian provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Leonardo Calo’, MD, FESC, Division of Cardiology, Policlinico Casilino, ASL Rome B. Via M Buonarroti 16, 00169 Rome, Italy. leonardo.calo@tin.it
Telephone: +39-06-23188416 Fax: +39-06-23188410
Received: June 30, 2015
Peer-review started: July 12, 2015
First decision: August 15, 2015
Revised: October 2, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: December 26, 2015
Processing time: 180 Days and 21.2 Hours
Abstract

AIM: To compare the utility of the partners-heart failure (HF) algorithm with the care alert strategy for remote monitoring, in guiding clinical actions oriented to treat impending HF.

METHODS: Consecutive cardiac resynchronization-defibrillator recipients were followed with biweekly automatic transmissions. After every transmission, patients received a phone contact in order to check their health status, eventually followed by clinical actions, classified as “no-action”, “non-active” and “active”. Active clinical actions were oriented to treat impending HF. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of the partners-HF algorithm vs care alert in determining active clinical actions oriented to treat pre-HF status and to prevent an acute decompensation, were also calculated.

RESULTS: The study population included 70 patients with moderate to advanced systolic HF and QRS duration longer than 120 ms. During a mean follow-up of 8 ± 2 mo, 665 transmissions were collected. No deaths or HF hospitalizations occurred. The sensitivity and specificity of the partners-HF algorithm for active clinical actions oriented to treat impending HF were 96.9% (95%CI: 0.96-0.98) and 92.5% (95%CI: 0.90-0.94) respectively. The positive and negative predictive values were 84.6% (95%CI: 0.82-0.87) and 98.6% (95%CI: 0.98-0.99) respectively. The partners-HF algorithm had an accuracy of 93.8% (95%CI: 0.92-0.96) in determining active clinical actions. With regard to active clinical actions, care alert had a sensitivity and specificity of 11.05% (95%CI: 0.09-0.13) and 93.6% respectively (95%CI: 0.92-0.95). The positive predictive value was 42.3% (95%CI: 0.38-0.46); the negative predictive value was 71.1% (95%CI: 0.68-0.74). Care alert had an accuracy of 68.9% (95%CI: 0.65-0.72) in determining active clinical actions.

CONCLUSION: The partners-HF algorithm proved higher accuracy and sensitivity than care alert in determining active clinical actions oriented to treat impending HF. Future studies in larger populations should evaluate partners-HF ability to improve HF-related clinical outcomes.

Keywords: Heart failure; Cardiac resynchronization therapy; Defibrillators; Remote monitoring

Core tip: This is a multicenter observational registry that compared the utility of the partners-heart failure (HF) algorithm with the care alert strategy for remote monitoring, in guiding clinical actions oriented to treat impending HF in a population of 70 cardiac resynchronization therapy recipients followed over a mean follow-up period of 8 ± 2 mo. The partners-HF algorithm displayed high sensitivity (96.9%), specificity (92.5%), positive (84.6%) and negative (98.6%) predictive values for active clinical actions oriented to treat impending HF. The care alert exhibited lower sensitivity (11.1%), positive (42.3%) and negative (71.1%) predictive values.