Heart & Lung最新文献

{"title":"LUDT-ADHF trial: Lung ultrasound-guided diuretic therapy for hospitalized patients with acute decompensated heart failure: An open-label clinical trial","authors":"Masoud Kashoob MD ,&nbsp;Salim Al-Busaidi MD ,&nbsp;Juhaina Salim Al-Maqbali MSc ,&nbsp;Amira Al-Badi MD ,&nbsp;Aya Aalhamad MD ,&nbsp;Zubaida Al Falahi MD ,&nbsp;Aisha Al Huraizi MD ,&nbsp;Hatem Al Farhan MD ,&nbsp;Khalfan Al Zeedy MD ,&nbsp;Abdul Hakeem Al Hashim MD ,&nbsp;Mohammed H Al-Ghailani MD ,&nbsp;Muhammad Shoaib FRACP ,&nbsp;Haitham El Bingawi MD ,&nbsp;Abdullah M. Al Alawi FACP,FRACP","doi":"10.1016/j.hrtlng.2024.10.001","DOIUrl":"10.1016/j.hrtlng.2024.10.001","url":null,"abstract":"<div><div><strong>Background</strong> Acute Decompensated Heart Failure (ADHF) constitutes a major reason for hospital admissions and significantly contributes to increased morbidity and mortality. Limited research indicates that lung ultrasound (LUS) may enhance the care for patients with ADHF.</div><div><strong>Objective</strong>s The purpose of this study was to evaluate the impact of LUS-guided diuretic therapy on reducing length of hospital stay (LOS) and 90-day readmissions among patients with ADHF.</div><div><strong>Methods</strong> This open-label, non-randomized clinical trial included patients with ADHF managed with diuretics based on LUS findings of B-lines and pleural effusion (LUS group) compared to those receiving standard care (control group). The primary outcome was LOS during the index admission, and secondary outcomes included 90-day ADHF readmissions, all-cause readmissions, and safety parameters like acute kidney injury, hypokalemia, and hypotension.</div><div><strong>Results</strong> The study included a total of 77 patients, segregated into two groups: control and LUS. The median age of the patients was 68 years, with women slightly outnumbering men (53.25%, n=41). The most prevalent comorbidities were hypertension (88.31%, n=68), diabetes mellitus (59.74%, n=46), and chronic kidney disease (66.23%, n=51). The LUS group had a shorter LOS, though not statistically significant (4 vs five days, p= 0.175). Patients in the LUS group had significantly fewer 90-day ADHF readmissions compared to the control group (10.53% vs. 35.9%; p&lt;0.01). Survival analysis demonstrated that the LUS group had a longer time to 90-day ADHF readmissions, with a hazard ratio (HR) of 0.24 (95% CI: 0.08–0.75, p=0.014). For 90-day all-cause readmissions, the LUS group also showed a longer time to readmission compared to controls, with an HR of 0.45 (95% CI: 0.200–1.005, p=0.046). For other safety measures, there was no significant difference in the incidence of adverse events, including acute kidney injury, hypokalaemia, or hypotension, between the LUS and control groups.</div><div><strong>Conclusion</strong> LUS might reduce in-hospital mortality and readmissions among adults with acute decompensated HF. However, further double-blinded randomized clinical trials are needed to confirm these preliminary results.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 155-162"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and age predict advanced heart failure in gene-negative patients with hypertrophic cardiomyopathy","authors":"Fangfang Ji ,&nbsp;Xueshou Yu ,&nbsp;Wenxu Sheng ,&nbsp;Wenxiu Zhang ,&nbsp;Ying Wei ,&nbsp;Xiaobin Ji ,&nbsp;Zhengyi Shan ,&nbsp;Lin Qi","doi":"10.1016/j.hrtlng.2024.10.006","DOIUrl":"10.1016/j.hrtlng.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with hypertrophic cardiomyopathy (HCM) may develop concomitant advanced heart failure (HF). However, there is limited data on the clinical outcomes of HCM patients without sarcomere gene mutations who have advanced HF.</div></div><div><h3>Objectives</h3><div>To identify prognostic factors for advanced HF in gene-negative patients within a large HCM cohort.</div></div><div><h3>Methods</h3><div>A total of 1529 unrelated patients with HCM were enrolled between 1999 and 2018, and followed throughout the study period. All patients underwent genotyping through whole exome or panel sequencing. From this cohort, 735 patients without mutations were studied. We assessed the effects of family history, clinical findings, and echocardiographic parameters on the development of advanced HF. Multivariable Cox proportional hazards regression analysis was conducted to identify risk factors associated with advanced HF.</div></div><div><h3>Results</h3><div>Of the 735 gene-negative patients studied, the mean age was 52.5±13.2 years, 69.5% were male, and the mean follow-up duration was 3.2±2.3 years. During this period, 97 patients (13.2%) developed advanced HF. Using multivariable analysis, we identified significant risk factors for advanced HF: female gender (adjusted hazard ratio [HR] 2.499, 95% confidence interval [CI] 1.531–4.081, P&lt;0.001) and older age at enrollment (adjusted HR 1.298, 95% CI 1.00–1.682, P=0.049). These findings suggest that female patients and those enrolled at an older age are at a higher risk for developing advanced HF.</div></div><div><h3>Conclusion</h3><div>Female gender and older age may predict a higher risk of advanced HF in gene-negative patients with HCM. Early detection and proactive treatment are crucial for managing and preventing complications in these patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 163-167"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Treg cells and cytokines in the peripheral blood of patients with coronary artery disease combined with type 2 diabetes mellitus","authors":"Runqi Liu ,&nbsp;Jinghui Bao ,&nbsp;Ying Tang ,&nbsp;Danyan Xu ,&nbsp;Li Shen ,&nbsp;Huali Qin","doi":"10.1016/j.hrtlng.2024.10.004","DOIUrl":"10.1016/j.hrtlng.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with coronary artery disease (CAD) combined with type 2 diabetes mellitus (T2DM) develop serious atherosclerotic and diffuse lesions. Inadequate numbers and the dysfunction of CD4⁺CD25⁺Foxp3⁺regulatory T lymphocytes (Treg cells) are common mechanisms underlying the immunopathological damage in CAD and T2DM.</div></div><div><h3>Objectives</h3><div>We aimed to explore Treg cell changes in patients with CAD complicated with T2DM and to investigate the association between Treg cells and the severity of CAD.</div></div><div><h3>Methods</h3><div>A total of 257 participants were included in the study, divided into a healthy control group (HC, <em>n</em> = 63), CAD group (<em>n</em> = 106), and CAD complicated with T2DM group (CAD+T2DM, <em>n</em> = 88). Flow cytometry detected Treg cell levels, and serum IL-10, IL-6, and ELISA detected TGF-β.</div></div><div><h3>Results</h3><div>The sample for this study consisted of 170 males and 87 females, with 88 (34.24 %) participants having diabetes and 169 (65.76 %) without diabetes. The proportion of circulating Treg cells was lower in the CAD and CAD+T2DM groups than in the HC group, and it was lower in the CAD+T2DM group than in the CAD group. The plasma levels of IL-10 and TGF-β were lower in the CAD than in the HC group, and the levels in the CAD+T2DM group were significantly lower than those in the CAD group. However, the plasma IL-6 level changed in the opposite direction. Gensini's score was negatively correlated with Treg cells (<em>R</em> = - 0.57, <em>P</em> &lt; .05). Subgroup analyses and interaction analyses showed that the association of Treg with the Gensini score was robust.</div></div><div><h3>Conclusion</h3><div>The level of Treg cells was an independent protective factor for patients with CAD and T2DM and was negatively correlated with the Gensini score. Therefore, Treg cells may be used as therapeutic targets for CAD with T2DM patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 147-154"},"PeriodicalIF":2.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of depressive symptoms and engagement in physical activity with event-free survival in patients with heart failure","authors":"Geunyeong Cha PhD (c), MSN, RN ,&nbsp;Misook L. Chung PhD, RN ,&nbsp;JungHee Kang PhD, RN ,&nbsp;Chin-Yen Lin PhD, RN ,&nbsp;Martha J. Biddle PhD, RN ,&nbsp;Jia-Rong Wu PhD, RN ,&nbsp;Terry A. Lennie PhD, RN ,&nbsp;Ashmita Thapa BSN, RN ,&nbsp;Debra K. Moser PhD, RN","doi":"10.1016/j.hrtlng.2024.10.003","DOIUrl":"10.1016/j.hrtlng.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) subtype, depressive symptoms, and physical inactivity independently contribute to survival outcomes, but the effect of the interaction of these variables on survival outcomes remains unknown.</div></div><div><h3>Objectives</h3><div>We aimed to determine whether depressive symptoms and engagement in physical activity differentially interact to predict the combined endpoint of all-cause death or rehospitalization among patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF).</div></div><div><h3>Methods</h3><div>This study was a secondary analysis. The sample was categorized by the presence or absence of depressive symptoms, and engagement or non-engagement in physical activity. Cox proportional hazard modeling was used to predict the combined endpoint of all-cause death or rehospitalization.</div></div><div><h3>Results</h3><div>A total of 1002 patients with HF were included (mean age 64.3 ± 12.7 years; 637 males [64 %]; 844 White [84 %]). Among them, 35.3 % did not engage in physical activity, while 64.7 % engaged in any level of physical activity, and 29.7 % had depressive symptoms. In both subtypes, depressive symptoms were associated with the highest risk of all-cause death or rehospitalization. Among patients with HFrEF, those with depressive symptoms who did not engage in physical activity were associated with a 136 % higher risk of the combined endpoint, while among those with HFpEF, depressive symptoms and engagement in physical activity were associated with a 78 % higher risk.</div></div><div><h3>Conclusions</h3><div>Depressive symptoms and lack of physical activity predicted the combined endpoint of all-cause death or rehospitalization among patients with HFrEF, while depressive symptoms alone were the strongest predictor among patients with HFpEF.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 138-146"},"PeriodicalIF":2.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of survival rate and quality of life in axial-flow pump left ventricular assist devices (LVADs)","authors":"Amin Khorshid Savar ,&nbsp;Hongrui Wang,&nbsp;Nuo Chen,&nbsp;Yunzhang Cheng","doi":"10.1016/j.hrtlng.2024.09.012","DOIUrl":"10.1016/j.hrtlng.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>The rising heart failure rates globally show the pressing demand for treatment progress, especially in Left Ventricular Assist Devices (LVADs). Axial-flow pump LVADs are gaining notice for their small size, few moving parts, and potential for miniaturization, providing a vital option for heart transplants during donor shortages.</div></div><div><h3>Objectives</h3><div>Despite several studies on LVADs, there is a notable lack of research specifically comparing axial-flow pumps with similar technology. This gap hinders the identification of the most optimal technology to guide development efforts and meet patient needs. This study aims to comprehensively compare the most commonly used axial-flow pumps and provide a detailed analysis focusing on survival rates and quality of life parameters.</div></div><div><h3>Methods</h3><div>As a developer of axial-flow pumps (LVADs), our group conducted a systematic review of the current axial-flow pump LVADs. We analyzed studies comparing these devices, focusing on key metrics such as survival rates and quality of life.</div></div><div><h3>Results</h3><div>The HeartMate 2 and Jarvik 2000 show superior survival rates (up to 86.9 % at 6 months, 96.3 % at 3 years) and (6-month survival 67 %-91 %) respectively, compared to the other axial flow pumps LVAD. The results underscore the importance of choosing the optimal device and informing the direction of future developments.</div></div><div><h3>Conclusion</h3><div>In this paper, we aim to inform future studies to enhance their effectiveness and advance the overall performance of these devices, ultimately benefiting patients and developers. This review furnishes evidence-based recommendations for the most appropriate axial-flow pumps based on survival rates and quality of life parameters.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 127-137"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Board of Directors","authors":"","doi":"10.1016/S0147-9563(24)00176-6","DOIUrl":"10.1016/S0147-9563(24)00176-6","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page vii"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure Related Fatigue and Serum Osmolality: An Exploratory Analysis of the National Health and Nutrition Examination Survey","authors":"Christine R. Hoch PhD, RN, ACNS-BC,&nbsp;Jennifer Klinedinst,&nbsp;Karen Larimer,&nbsp;Stephen S. Gottlieb","doi":"10.1016/j.hrtlng.2024.08.003","DOIUrl":"10.1016/j.hrtlng.2024.08.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The purpose of this study was to explore the relationship of serum osmolality to HF-related fatigue, controlling for select physiologic covariates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Fatigue is a common symptom of heart failure (HF) associated with deleterious outcomes including increased morbidity and mortality. Underlying physiologic mechanisms of HF-related fatigue are not well understood. Hypervolemia and hypovolemia have been suggested as potential mechanisms of HF-related fatigue. Serum osmolality has been used as a physiologic measure to assess changes in volume status with therapeutic treatments to manage fluid imbalances. Low serum osmolality is associated with increased risk of mortality and hospital readmission in persons with HF. However, the relationship of serum osmolality and HF-related fatigue has not been well described.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We analyzed cross-sectional data from two waves of the National Health and Nutrition Examination Survey (2015-2016 and 2017-2018). Adults who self-reported having HF without co-morbid conditions known to contribute to fatigue were included in the study (unweighted n = 126). Data were weighted to provide US national estimates, and complex sample design used for analyses. Independent t tests and chi-square tests were used to explore differences between fatigued and nonfatigued adults with HF. Logistic regression analyses were used to calculate the odds of having fatigue. Bivariate logistic regression models were performed to assess the individual contributions of select physiologic covariates: age, sex, hemoglobin, body mass index (BMI) and presence of shortness of breath. Covariates with a significance of p≤.10 were included in the final model. Multivariate logistic regression was performed on the presence of fatigue as the outcome with physiologic predictors selected from the bivariate analysis: BMI and serum osmolality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Being female was associated with higher odds of experiencing fatigue when controlling for serum osmolality and body mass index (OR=4.91, p&lt;.001, CI 2.200 – 10.954). Serum osmolality was lower in those that experienced fatigue compared to those without fatigue (t=-2.37, p=.032) Higher serum osmolality was associated with 7.6% lower odds of experiencing fatigue when controlling for sex and BMI (OR=.924, p=.014, CI .870 - .982).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Despite the deleterious outcomes associated with HF-related fatigue, physiologic mechanisms remain poorly understood. Serum osmolality may be associated with the experience of fatigue in persons with HF. Serum osmolality reflects the concentration of serum sodium, urea, and glucose. The differences in serum osmolality noted may be explained by dietary sodium, serum blood glucose, fluid restrictions or use of diuretics. Yet, serum osmolality is associated with mortality in persons with HF, suggesting changes in serum osmolality ma","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 381-382"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Your Patient Need An Implanted Cardiac Defibrillator?","authors":"Jessica Bocchino MSN, RN-BC,&nbsp;Zoya Shir,&nbsp;Valerie Mc Donough","doi":"10.1016/j.hrtlng.2024.08.004","DOIUrl":"10.1016/j.hrtlng.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this Quality Improvement Project was to identify heart failure patients who met criteria for an Implanted Cardiac Defibrillator.</div></div><div><h3>Background</h3><div>Patients with heart failure are at risk of ventricular arrhythmias. Implantable cardiac defibrillators (ICDs) can significantly reduce sudden cardiac death. Unfortunately, ICD implantation is often underutilized. Based on studies, the American College of Cardiology and American Heart Association recommend ICDs in patients with depressed Ejection Fractions (EF) and heart failure. The Centers for Medicare &amp; Medicaid Services have approved reimbursement for ICD placement in patients meeting criteria.</div></div><div><h3>Methods</h3><div>The Heart Failure Coordinators at Hackensack University Medical Center screened heart failure patients admitted to the hospital. Through real time screening and participation in Multidisciplinary Rounds (MDRs) we reviewed patients echocardiograms for ejection fractions (EF) of &lt; _35%, New York Heart Association (NYHA) class I-III and ensured the patient had received optimal medical therapy for at least 3 months. Those with a terminal illness, life expectancy, cognitive or severe psychiatric illness were not included. If patients met criteria a recommendation was sent to the provider for a possible consultation to Electrophysiology (EP). Additionally, the Heart Failure Algorithm was modified to suggest EP consults for patients with EF&lt; 35%.</div></div><div><h3>Results</h3><div>Improvements in our compliance to the Get With The Guidelines- Heart Failure (GWTG-HF) Quality Measure AHAHF12: ICD Counseling or ICD Placed or Prescribed at Discharge increased by 20% from Quarter 1 203 to Quarter 2 2023 and additionally increased by 7% in Quarter 3. Through daily screening and the use of the Heart Failure Algorithm, cases were identified and presented at our monthly Heart Failure Adjudication meetings. These presentations not only assisted in referrals to EP, but also captured our audience. The presentations increased the awareness of our medical centers providers.</div></div><div><h3>Conclusion</h3><div>The use of daily screening increased referrals to Electrophysiology and identification of patients that met criteria for for device therapy. Consideration of ICD implantation must be a shared decision making process. As the population for heart failure continues to grow, device therapy can improve overall survival. It is vital to remain aware of technologies and devices that can refine management of complexed heart failure care.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page 383"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from Implementing an AI-Enabled Peripheral Edema Monitor in UK-based Community Settings for Therapeutic Decision-Making","authors":"Oriane Chausiaux PhD, MsC, BsC, MPhil,&nbsp;Gareth Williams,&nbsp;Melanie Keyser,&nbsp;Michał Nieznański,&nbsp;Philip Downer,&nbsp;Anna Zieba,&nbsp;Lewis Bond,&nbsp;Jakub Zieba,&nbsp;Shamus Husheer","doi":"10.1016/j.hrtlng.2024.08.006","DOIUrl":"10.1016/j.hrtlng.2024.08.006","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the implications of deploying a telemonitoring device in the homes of patients with heart failure through family doctors.</div></div><div><h3>Background</h3><div>In recent years, a decline in in-person primary healthcare consultations has posed significant challenges, especially for elderly patients with heart failure, who often contend with multiple comorbidities. A notable concern is their lack of awareness regarding symptom changes, such as weight gain, breathlessness, or swelling of the feet.</div></div><div><h3>Methods</h3><div>A cohort of 122 patients from 11 primary care practices across the UK were equipped with connected weighing scales and an AI monitoring device, including an internet dongle when necessary. These patients primarily resided in socioeconomically deprived areas. The study focused on device acceptability, utilization rates, and the impact of generated alerts on clinical teams. Initially planned for a six-month duration, a majority of participants opted to extend their use of the AI-device.</div></div><div><h3>Results</h3><div>The deployment targeted high-risk patients with heart failure, characterized by complex health conditions and histories of non-adherence with self-checks.</div><div>Data availability was high, with usage statistics indicating:</div><div>Weighing scale usage (at least once = 60.7%; at least 16days/mth = 5.7%)</div><div>AI-device usage (at least once = 100%; at least 16days/mth = 71.3%)</div><div>This indicates the AI device's passive, automated nature may enhance data collection from traditionally disengaged patient groups. Acceptability was high, with few rejections and of the 40% of participants responding to usability surveys, 92% would likely recommend the device to a friend. Alert management did not significantly burden GP teams, with most alerts being relevant to heart failure or other critical conditions needing attention (COPD exacerbation, COVID-19 infection, lymphoedema etc.). GP feedback was notably positive, especially from practices with a dozen or more participating patients.</div></div><div><h3>Conclusion</h3><div>Despite the challenging chosen patient group (representative of the high-risk heart failure population in the area), data acquisition was excellent, allowing clinicians to get an overview of the patient's health status remotely. While the investigation was not a randomized controlled trial (RCT), anecdotal evidence suggests early problem identification without significantly increasing GP workload. Further research is essential before broader implementation. The pivotal trial for the AI-device is expected to take place in the US in 2025.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page 385"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Heartfelt Device's Predictive Value in Heart Failure Management: Findings from the Multicenter FOOT Trial (UK)","authors":"Matthew Dewhurst MBBS, MRCP, MD NHS,&nbsp;Karen Hann,&nbsp;Iain Matthew,&nbsp;Lisa Gallagher,&nbsp;Gemma McCafferty,&nbsp;Hayley McKie,&nbsp;Sara Pick,&nbsp;Debbie Hughes,&nbsp;Louise Clayton,&nbsp;Will Nicolson,&nbsp;Susan Gent,&nbsp;Ganesan Kumar,&nbsp;Phil Keeling","doi":"10.1016/j.hrtlng.2024.08.005","DOIUrl":"10.1016/j.hrtlng.2024.08.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This study (NCT04072744) investigates the Heartfelt device's ability to predict heart failure events by monitoring peripheral edema, comparing its accuracy and data reliability against traditional daily weight monitoring. It aims to determine the device's effectiveness in providing early warnings to healthcare providers, patients, and caregivers about impending heart failure decompensations and assesses whether adjustments in alert sensitivity could improve patient outcomes, identifying the most efficient approach for ongoing heart failure management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The Heartfelt device, a CE-marked device covered by FDA exemption, allows heart failure monitoring at home by using 3D imaging and AI to detect peripheral edema changes autonomously, requiring no patient input to collect data. In Europe it is regulated to send alerts on potential heart failure risks to patients, families, or providers based on its findings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The FOOT study enrolled 26 patients from five UK NHS hospitals between February 2020 and June 2022. They used the Heartfelt HF3 device at home, which operated normally but logged data and alerts without informing patients or healthcare teams to prevent bias, as well as Bluetooth scales for daily weight tracking as part of standard care. After six months, clinical records were reviewed for heart failure incidents.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the cohort using the Heartfelt device, 9 heart failure events were recorded in 8 patients, including 2 outpatient visits, 6 hospital admissions, and one fatality, with the device providing an average lead time of 13 days (6.5-20) for deterioration. For standard care (daily weighing), there was an average of 1.1 days [0.3-4.1] of data each week versus 5.9 days [4.9-6.6] of foot volume data weekly recorded by the Heartfelt device. Before 5 of the hospitalizations and one death, the Heartfelt device issued alerts within the preceding two weeks. Alerts also preceded both outpatient incidents; however, the devices had been persistently alerting approximately weekly for several weeks prior, potentially due to excessively sensitive thresholds, so the outpatient events were counted as missed. In total, 6 out of the 9 heart failure events were deemed to be successfully predicted in advance.&lt;/div&gt;&lt;div&gt;Most patients lacked consistent weighing scale data due to adherence issues despite patients being told to follow the advice of regular weighing during the study. Yet, the weight data available indicated that at least 2 events (1 hospitalization and 1 death) could have been predicted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The Heartfelt device demonstrates superior capability in detecting peripheral edema indicative of heart failure worsening, offering more reliable data collection than traditional weight monitoring. Its predictive alerts potentially afford clinicians and caregivers an early warning system, a","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 383-385"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}