Predicting worsening heart failure hospitalizations in patients with implantable cardioverter defibrillators: Is it all about alerts? A pooled analysis of nine trials

Background and aims: To predict worsening heart failure hospitalizations (WHFH) in patients with implantable defibrillators and remote monitoring (RM), the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24-hour heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity, and thoracic impedance. We compared temporal trends of the HF score and its components 12 weeks before a WHFH with 12-week trends in patients without WHFH, to assess whether trends indicate deteriorating HF regardless of alert status. Methods: Data from nine clinical trials were pooled, including 2,050 patients with a defibrillator capable of atrial sensing, ejection fraction ≤ 35%, NYHA class II/III, no long-standing atrial fibrillation, and 369 WHFH from 259 patients. Results: The mean HF score was higher in the WHFH group than in the no WHFH group (42.3 ± 26.1 versus 30.7 ± 20.6, p < 0.001) already at the beginning of 12 weeks. The mean HF score further increased to 51.6 ± 26.8 until WHFH (+22% versus no WHFH group, p = 0.003). As compared to the no WHFH group, the algorithm components either were already higher 12 weeks before WHFH (24 h HR, HR variability, thoracic impedance) or significantly increased until WHFH (nocturnal HR, atrial tachyarrhythmia, ventricular extrasystoles, patient activity). Conclusion: The HF score was significantly higher at, and further increased during 12 weeks before WHFH, as compared to the no WHFH group, with seven components showing different behavior and contribution. Temporal trends of HF score may serve as a quantitative estimate of HF condition and evolution prior to WHFH

Impact of lockdown during Covid‐19 pandemic on physical activity and arrhythmia burden in heart failure patients

Background Restricted outdoor activity during COVID-19 related lockdown may accelerate heart failure (HF) progression and thereby increase cardiac arrhythmias. We analyzed the impact of March/April 2020 lockdown on physical activity and arrhythmia burden in HF patients treated with cardiac resynchronization therapy (CRT) devices with daily, automatic remote monitoring (RM) function. Methods The study cohort included 405 HF patients enrolled in Observation of Clinical Routine Care for Heart Failure Patients Implanted with BIOTRONIK CRT Devices (BIO|STREAM.HF) registry in 16 countries, who had left ventricular ejection fraction (LVEF) = 8 min/day in 46.5% of patients; predictors were higher LVEF, lower NYHA class, no defibrillator indication, and more activity before lockdown. AHRE burden increased by >= 17 min/day in 4.7% of patients; predictors were history of atrial fibrillation, higher LVEF, higher body mass index, and activity decrease during lockdown. Conclusion Unfavorable changes in physical activity, AHRE burden, and follow-up rate were observed during lockdown, but not in ventricular arrhythmia

CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients—who is doing what to whom and how?

Background: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008–2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. Methods and results: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. Conclusion: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy

Quality of Life of Patients with Arrhythmia

Introduction: Quality of life must be perceived in two levels - objective and subjective. Heart arrhythmia is a disease of the cardiovascular system that, by its subjective and objective symptoms, can affect the individual's life physically, mentally, and also socially. It can limit a person in his or her everyday activities or in activities that make them happy or satisfied.Objectives: The aim of the research was to map the quality of life of patients with arrhythmia and to verify whether the duration of arrhythmia has an effect on the quality of life of patients with arrhythmia.Methods: A standardized ASTA (Arrhythmia - Specific Questionnaire in Tachycardia and Arrhythmias) questionnaire was used to collect quantitative data. The research group consisted of adult patients diagnosed with hearth arrhythmia, hospitalized at the Department of Cardiology of the Ceske Budejovice Hospital (Nemocnice České Budějovice a.s.). A total of 127 valid questionnaires were used for data processing.Results: The research revealed that the most common symptom of arrhythmia in 58% cases was rapid heartbeat, irregular heartbeat, and a sense of heart failure. Most respondents agreed with the claim that heart rhythm disorder makes it impossible for them to perform work, study, and perform daily life activities. No statistically significant differences were found in the evaluation of the influence of the arrhythmia duration on the patients' quality of life.Conclusions: Arrhythmia duration in the selected sample does not affect the overall health status and quality of life measured by the ASTA series questionnaires. Arrhythmia restricts the patient to perform work tasks, study, and perform daily life activities