Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Development and feasibility of a home telemonitoring program for advanced heart failure patients on ventricular assist device support
J. Hoffmann1, M. Papathanasiou1, A. M. Jakstaite1, A. Ruhparwar2, J.-N. Strickling3, T. Pulickal3, C. A. Perings3, T. Rassaf1, P. Lüdike1
1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Essen; 3Medizinische Klinik I, Katholisches Klinikum Lünen/Werne GmbH, Lünen;
Background:
Ventricular assist devices (VAD) have emerged as standard of care in selected patients with advanced heart failure to improve survival and quality of life as a bridge to transplant, bridge to recovery or destination strategy. Despite improved survival rates serious complications remain a shortcoming of this therapy and structured follow up of these patients is mandatory. The mode and intensity of follow up after VAD implantation varies significantly across regions and health care systems and no standard of care is defined yet. Home telemonitoring (HT) in addition to usual care (UC) has the potential to prevent complications and reduce hospitalizations. We here aimed to investigate the feasibility of home telemonitoring by a certified telehealth center in VAD recipients.

Methods:
This is an ongoing prospective interventional study. Patients with VAD are being recruited during their visits at the outpatient heart failure clinic and are assigned to HT in addition to UC after providing informed consent. All patients undergo routine in person follow up visits at a three-month interval post VAD implantation. Furthermore, study patients are interviewed by telephone via a certified telemonitoring center three times per week regarding symptoms of heart failure, VAD parameters (power, flow and revelations per minute), driveline exit site appearance and the occurrence of melena as a sign of occult gastrointestinal bleeding. International normalized ratio (INR) values, body weight and body core temperature are automatically transmitted to the telehealth center by telemonitoring products with capability of data transmission. Treating physicians at our site are informed according to predefined algorithms and cut-offs in case of relevant issues in which case further medical contacts or hospitalizations are being arranged. Hospitalization rate, duration and reason for hospitalization after 12 months will be analyzed among patients on HT and will be compared with equal number of patients receiving UC after matching for parameters reflecting disease severity. Quality of life, compliance and severity of depressive symptoms are monthly assessed via phone interview by the telehealth facility based on validated questionaires.

Results:
Overall 37 patients on VAD support are recruited in this study to date and were assigned to HT of whom 32 patients completed 6-month follow up. Mean age is 56 and Heart Mate III is the more frequent type of implanted VAD (n=25), followed by HeartWare (n=5) and Berlin Heart ExCor VAD (n=2). After 6 months one patient died, one received heart transplant and the remaining completed 6 month follow up. Mortality at 6-month follow up was 3% in the HT group. No patients withdrawed their consent to date. It remains a matter of further investigation to analyze the net benefit of HT as a mean to abort adverse events, hospitalizations and death during a 12-month period. Conclusion: These early results of this pilot prospective study demonstrate for the first time that a comprehensive HT can be used to accomplish management decisions in VAD patients remotely with high patient acceptance. We believe that these findings will have important implications during the current novel coronavirus disease-2019 pandemic. Prospective long term follow up and further analysis are awaited to evaluate feasibility and safety of HT in the long-term and its efficacy to reduce adverse events in the high-risk VAD population.

https://dgk.org/kongress_programme/jt2022/aP1192.html