Prevention of heart failure hospitalization based on remote monitoring and early intervention

Abstract

Remote monitoring (RM) has emerged as a critical tool in managing heart failure (HF) patients (P). HF algorithms can identify P with high risk of 30-day decompensation by combining parameters such as thoracic impedance, arrhythmia burden, percentage of right ventricular pacing, night ventricular rate, or patient activity levels. A multidisciplinary approach in RM leads to earlier therapeutic interventions, possibly impacting patient outcomes. We analyzed data from patients with HF and cardiac electronic implantable devices, under RM, focusing on high-risk alerts and examining the relationship between therapeutic interventions and hospitalization outcomes. The sample included 49 P (69.4% male, median age 76 years), with various HF etiologies. A single-center retrospective analysis of high-risk alerts using two different algorithms (Triage HF, Medtronic®; and HeartLogic, Boston Scientific®) was conducted. We sought to study 30-day hospitalizations in P with high-risk alerts and their correlation with therapeutic interventions using chi-square tests. There were 55 high-risk alerts from January 2024 to November 2025. Of these high-risk alerts, 72.7% were related to increased thoracic impedance, 56.4% to low patient activity, and 52.7% to increased night ventricular rates. Therapeutic interventions occurred in 56.4% of these cases, while 43.6% were maintained under regular surveillance. Of all interventions, 71% were based on increasing diuretics. In two years, there were only 2 hospitalizations in 30 day follow-up of the alerts, suggesting that most interventions were successful and the surveillance strategy was well identified and applied. RM provides valuable insights into HF decompensation risk, with congestion and low activity being predominant triggers for high-risk alerts. From a total of 55 high-risk alerts only 3.6% required hospitalization. This suggests the important role of an RM programme in HF P in lowering hospitalizations.