Скачать или смотреть An Update on Remote Monitoring to Cut Heart Failure Hospitalization

Jag Singh talks with heart failure expert William Abraham about remote monitoring strategies in patients with heart failure.
https://www.medscape.com/viewarticle/...

-- TRANSCRIPT --
Jagmeet P. Singh, MD, PhD: Hi. I'm Jag Singh from Medscape Cardiology. I'm delighted to be here. I have with me Bill Abraham, who is a distinguished professor of medicine from Ohio State University, as well as one of the most world-renowned heart failure physicians that I know.

We're going to be talking today about remote monitoring in heart failure. Bill has done a great deal of work in this arena.

As an electrophysiologist, I've been doing remote monitoring for a while, but it's really focused on devices. Heart failure is a different ball game completely. Can you give us an idea of what your practice for remote monitoring in the heart failure patient entails?

Stand Alone Devices for Congestion Management
William T. Abraham, MD: First of all, Jag, it's a pleasure to join you and thank you for the kind introduction. Look, we're behind in heart failure in remote monitoring of our patients, and I'm somewhat envious of the electrophysiologists. Certainly, we've learned from you, and we need to apply those learnings to the management of patients with heart failure.

Managing congestion in heart failure really is the key to keeping our patients with heart failure well and keeping them out of the hospital. The problem is that on a day-to-day basis, it's difficult to judge the degree of congestion that our patients have, particularly when they're at home.

In our practice, we're increasingly adopting emerging technologies that give us direct measurements of either intracardiac or pulmonary artery pressures or at least give us some physiologic measures that may be predictive of future heart failure events.

Singh: These devices that we electrophysiologists implant have many diagnostics sensors: You can measure heart rate, transthoracic impedance, respiratory rate, heart sounds, all of those things. Some of them even offer the opportunity of integrating these signals to predict which patients might actually end up having heart failure.

What do you think is the role of these device-based sensors, vis-à-vis the standalone sensors like pulmonary artery pressure monitoring or direct left atrial pressure monitoring? Where do you think the field is going and how do you correlate these two?

Abraham: First, we should definitely leverage and take advantage of the information provided by cardiac implanted electronic devices like pacemakers and defibrillators. In that regard, I'll just mention parenthetically, primary prevention, implantable cardioverter defibrillators, and cardiac resynchronization therapy are underutilized in the management of patients with heart failure. I would encourage the audience to follow guidelines and aggressively or more aggressively use those devices in their patients with heart failure.

For those who have these devices, we can get a large amount of information that seems to be highly predictive of future heart failure events, such as a heart failure hospitalization. I think the limitation of those approaches to date has been that much of the information is not directly actionable. It predicts risk. It tells you who to worry about more and who to worry about less. It doesn't necessarily enable day-to-day management changes. You don't necessarily know when to increase the dose of the diuretic, for example, or how much.

That's why I think the standalone implantable hemodynamic monitors play a big role. They give us an absolute measure of either left atrial or pulmonary artery pressure. Because we understand what those pressures mean and because the values are absolute rather than relative, they're actionable.

If, for example, the pulmonary diastolic pressure goes from something in the normal range to something that's elevated, we can simply implement an algorithm of increased diuretic use that will restore it to normal and avert a hospitalization. That's now demonstrated to work in multiple randomized controlled and observational studies.

Singh: Many patients don't have standalone devices, right? But they have these devices which give all these different parameters. Do you feel the construct of a remote monitoring pathway where you have clinicians who interact with the patients with the device-based data can really make a better decision than without having these data?

https://www.medscape.com/viewarticle/...