[Remote monitoring in patients with heart failure and ventricular dysfunction: operating protocol of Trieste Cardiology].

Abstract

Chronic heart failure is a condition characterized by an increasing epidemiological impact, ranking among the leading causes of morbidity and mortality, and often requiring complex and costly outpatient and hospital management. Patients with heart failure with reduced left ventricular systolic function who have implantable cardiac defibrillators with or without cardiac resynchronization therapy can now benefit from innovative telemonitoring algorithms designed to predict acute decompensated heart failure and to promote early prevention and treatment strategies. Composite indices generated by devices from Boston Scientific (HeartLogic™), Biotronik (HeartInsight), and Medtronic (TriageHF), through multiparametric scores and specific alert notifications, indicate hemodynamic changes in the subclinical and often asymptomatic phase with high sensitivity and specificity, forewarning of acute destabilizations. This review proposes an organizational model aimed at an integrated and coordinated management of heart failure alerts between the hospital (particularly the Pacemaker and the Heart Failure Clinic of Cardiology in Trieste) and the regional Cardiology network, following uniform diagnostic and therapeutic criteria. By drafting a management protocol, our Cardiology department monitors heart failure patients with reduced systolic function using a flowchart that categorizes patients by risk of acute events, starting from the alert and a simple phone contact. Stable patients are monitored remotely for 2 weeks until the heart failure alert resolves, but if the alert persists, they are referred to the Heart Failure section or regional Cardiology for further management. In-alert patients with two or more objective signs/symptoms of heart failure are provided with educational and behavioral advice and have their current therapy adjusted, with remote follow-up every 15 days. If the alert persists for more than 2 weeks after onset, the case is forwarded to the Heart Failure section for a phone reassessment and further investigation, including blood tests and NT-proBNP level measurements.