AIMS:

Heart failure (HF), a global epidemic, is associated with significant hospitalization in the EU and US, and consequently poses a significant clinical and socioeconomic burden. Routine management of HF involves in-person care. We hypothesize that remote patient management (RPM) through Cordella® HF System (Endotronix Inc, Lisle, IL USA) (CHFS) will drive better outcomes compared to the usual standard of care with appropriate Guideline Directed Medical Therapy (GDMT) optimization, thus reducing routine hospital visits.

METHODS AND RESULTS:

CHFS was deployed to 30 HF patients (Mean age 71; 66% Male) at University Hospital Galway, Ireland. All patients received remote training on the use of CHFS. The System uses Bluetooth enabled devices to collect vital signs (blood pressure, heart rate, body weight and oxygen saturation,) in addition to customized health questions via a wireless tablet. Clinicians used a cloud-based server to review patient information at-least twice weekly. GDMT optimization and lifestyle adjustments were communicated to patients via telephone calls and tablet-based messaging. Patient and clinic compliance was excellent and averaged to 92% and 94% respectively. Changes in blood pressure and weight were insignificant, however improvements in the frequency of medication titrations were observed. HF hospitalizations reduced by 54% (p<0.05) at 12-months post deployment (HR 0.46; 95% CI 0.455-3.012; p=0.01). The KCCQ overall summary score was unchanged from baseline through 6-months (53.7 ± 23.2 vs. 53.7 ± 21.3, P = 0.99). Three patients (12.5%) improved from NYHA Class 3 to Class 2 within 6-months, one patient (4%) transitioned from Class 4 to Class 1 at 12-months post deployment. No deterioration in NYHA was observed in the remaining group of HF patients.

CONCLUSION:

RPM facilitated real-time GDMT optimization and reduced HF hospitalizations in a small cohort of patients. Ongoing research focuses on maximizing patient engagement and compliance. Future work will focus on the impact of such RPM intervention in a large cohort of patients (controls v/s intervention), and expansion strategies with multiple clinics in Ireland including a team of general and advanced-nurse practitioners and community nurses.