Early Detection of Worsening Heart Failure in Patients at Home Using a New Telemonitoring System of Respiratory Stability

• Published in: Circulation Journal Vol. 86; no. 7; pp. 1081 - 1091
• Main Authors: Sakoda, Mika, Nakane, Eisaku, Harada, Daisuke, Noto, Takahisa, Inoko, Moriaki, Yamada, Tomomi, Takagawa, Junya, Asanoi, Hidetsugu, Wada, Osamu, Sakata, Yasushi, Miyagawa, Shigeru, Kurakami, Hiroyuki, Ohtani, Tomohito, Nakamoto, Kei, Sawa, Yoshiki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.06.2022
• Subjects: Heart failure; Heart Failure - diagnosis; Hospitalization; Humans; Prospective Studies; Respiratory instability; Respiratory stability time; Telemedicine - methods; Telemonitoring; Heart failure; Hospitalization; Respiratory stability time; Telemonitoring; Respiratory instability
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-21-0590

Background: Early detection of worsening heart failure (HF) with a telemonitoring system crucially depends on monitoring parameters. The present study aimed to examine whether a serial follow up of all-night respiratory stability time (RST) built into a telemonitoring system could faithfully reflect ongoing deterioration in HF patients at home and detect early signs of worsening HF in a multicenter, prospective study.Methods and Results: Seventeen subjects with New York Heart Association class II or III were followed up for a mean of 9 months using a newly developed telemonitoring system equipped with non-attached sensor technologies and automatic RST analysis. Signals from the home sensor were transferred to a cloud server, where all-night RSTs were calculated every morning and traced by the monitoring center. During the follow up, 9 episodes of admission due to worsening HF and 1 episode of sudden death were preceded by progressive declines of RST. The receiver operating characteristic curve demonstrated that the progressive or sustained reduction of RST below 20 s during 28 days before hospital admission achieved the highest sensitivity of 90.0% and specificity of 81.7% to subsequent hospitalization, with an area under the curve of 0.85.Conclusions: RST could serve as a sensitive and specific indicator of worsening HF and allow the detection of an early sign of clinical deterioration in the telemedical management of HF.