Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Impedance-based remote monitoring in patients with heart failure and concomitant chronic kidney disease
J. Wintrich1, V. Pavlicek1, J. Brachmann2, R. Bosch3, C. Butter4, H. Oswald5, K. Rybak6, D. Millenaar1, F. Mahfoud1, M. Böhm1, C. Ukena1
1Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar; 2Medical School / Regiomed GmbH, Coburg; 3Cardio Centrum Ludwigsburg Bietigheim, Ludwigsburg; 4Herzzentrum Brandenburg / Kardiologie, Immanuel Klinikum Bernau, Bernau bei Berlin; 5Klinikum Peine gGmbH, Peine; 6Praxis für Kardiologie und Angiologie, Mediclin MVZ, Dessau-Roßlau;

Background: Chronic kidney disease (CKD) represents a common comorbidity in patients with heart failure (HF), promoting hospitalization rates and mortality. Remote monitoring (RM) of thoracic impedance, which indicates pulmonary fluid level, might help to detect pulmonary congestion in HF patients at a very early stage, eventually preventing symptomatic cardiac decompensation. We investigated, whether the presence of CKD affects the efficacy of impedance-based RM in patients with chronic HF included in the OptiLink HF study.

Methods: Among HF patients included in the OptiLink HF study, we compared frequency of telemedical alert transmissions, subsequent handling of telemedical alert transmissions as well as the time to the primary endpoint (composite of cardiovascular hospitalization and all-cause death) according to the presence of concomitant CKD. Definition of appropriate contacts were: (1) initial telephone contact within 2 working days after alert transmission, (2) follow-up contacts according to study protocol, and (3) medical intervention initiated after alert transmission due to cardiac decompensation. CKD at baseline was defined as GFR<60ml/min/1,73m2.

Results: Of 1,002 patients enrolled in OptiLink HF, nearly a third (n=326) suffered from HF and concomitant CKD. Patients with CKD were older (71±8 years vs. 64±11 years; p<0.001) and more symptomatic (88% vs. 78% in NYHA III/IV; p<0.001) than patients without CKD, while there were no significant differences regarding gender (83% vs. 78% male; p=0.129) and left ventricular ejection fraction (LVEF) (26±6% vs. 27±6%; p=0.07). Within the intervention group of OptiLink HF, presence of CKD led to an increased transmission of telemedical alerts due to fluid overload (2 (1-5) vs. 1 (0-3) alert transmissions; p=0.012). Subsequent contacting after alert transmission in patients with HF and CKD was appropriate in only 60 (33-100)%. Furthermore, the risk of the primary endpoint was significantly higher in patients with CKD when compared to patients without CKD (Log rank p<0.001).

Conclusion: The presence of CKD in HF patients increases the risk of impedance-based telemedical alert transmissions and associates with poor prognosis. Inappropriate handling of alert transmission was more commonly observed in patients with chronic HF and CKD. Specific education programs for physicians might help to optimize patient care.
https://dgk.org/kongress_programme/jt2022/aP857.html