Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice.

INTRODUCTION: Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction <40% reduces the risk of readmission or death from any cause in a 'real-world' setting. METHODS: This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. RESULTS: Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). DISCUSSION: TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.

Telemonitoring predicts in advance heart failure admissions.

BACKGROUND: Heart failure (HF) is increasingly common and characterised by frequent admissions to hospital. To reduce the risk of HF hospitalisation (HFH), approaches as telemonitoring (TM) have been introduced. This study aimed to develop an algorithm for detecting patients at high risk of HFH, using daily collected physiological data (blood pressure, heart rate, weight) by non-invasive TM. METHODS: The analysis was based on home-TM data collected from a single centre as part of HF care. The prediction of HFH was considered as a signal processing and classification problem. Signal processing aimed to transform the signals to enhance the information relevant to HFH. We attempted to construct an algorithm that could identify such patterns and classify them as abnormal by assessing the predictive value of each of the monitored signals and their combinations using analysis of vectors (e.g. vectors of raw signal values, vectors of signals obtained by Multi-Resolution Analysis). RESULTS: The best predictive results were achieved with the combined used of weight and diastolic BP. The highest predictive performance was achieved using 8-day TM data (area under the receiver operator characteristic curve (AUC) 0.82±0.02). Prediction based on 4-day TM data was slightly less accurate with an AUC of 0.77±0.01. CONCLUSION: We have found that using an algorithm based on weight and diastolic blood pressure measured over 8days predicts heart failure admissions with a high degree of accuracy. The value of such an algorithm should be tested in clinical trials.

Coronary artery calcification correlates with the presence and severity of valve calcification.

AIM: To investigate the prevalence of coronary artery calcification (CAC) in symptomatic individuals with CT evidence for left heart valve calcification, aortic valve (AVC), mitral valve (MAC) or both. METHODS: This is a retrospective study of 282 consecutive patients with calcification in either the aortic valve or mitral annulus. Calcium scoring of the coronary artery, aortic and mitral valve was measured using the Agatston score. RESULTS: AVC was more prevalent than MAC (64% vs. 2.5%, p < 0.001), with 34% having both. Absence of CAC was noted in 12.7% of the study population. AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC+MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score >400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score >400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC. CONCLUSION: The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification.

Progression of coronary artery calcification in asymptomatic individuals with pre-existing calcium score.

AIM: Coronary artery calcification (CAC) has been introduced as a reliable, non-invasive marker of atherosclerosis. In this retrospective study, we investigated the progression of CAC using electron beam computed tomography. METHODS: The study enrolled 598 individuals (521 males; mean age: 59.3±8.3 years) with initial CAC score (CACS) ≥10. The mean interscan period was 2.4±1.35 years (range: 1-7 years). The mean CACS, for the entire cohort, was 262.4±423.9 at baseline scan and 380.3±547.6 at follow-up. The mean annualized progression in CACS was 57.7±123.7; 47.4±66.5 in females and 58.3±128.1 in males (P=0.46). The mean annualized progression in CACS was 39.6±61.3 in individuals <60 years and 75.7±161.5 in individuals >60 years (P=0.0003). In multivariate analysis, only baseline CACS (P<0.0001) and smoking (P=0.002) were independently associated with the annual change in CACS.

Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors.

BACKGROUND: Ethnic differences in prevalence and severity of coronary artery disease are well established and are usually attributed to risk factors variation. This study investigates the differences in coronary artery narrowing and coronary calcification between two age- and gender-matched cohorts of South Asian and Caucasian symptomatic angina patients. METHODS: We identified 101 symptomatic angina patients of South Asian origin who had undergone CT angiography and calcium scoring, and compared them with 101 age and gender matched Caucasian patients. RESULTS: South Asians had a greater mean number of arterial segments with both obstructive and non-obstructive plaque than Caucasians (p=0.006 and p=0.0003, respectively) and higher prevalence of triple-vessel disease (p=0.0004). Similarly, South Asians had a higher mean CAC score (p<0.0001) and the percentage of South Asians with CAC>0 and in all categories of CAC score 100-1000 were also higher, as was the number of arterial segments with calcified and non-calcified plaque. These results were more marked in patients aged >50 but in those ≤ 50, Caucasians showed a higher mean number of diseased segments (p=0.019), with non-obstructive plaque (p=0.02), possibly suggesting that Caucasians are likely to have more diffuse atherosclerosis at an earlier age. CAC prevalence and severity in this age-group were not significantly different between South Asians and Caucasians. CONCLUSION: Despite similar conventional risk factors for CAD, symptomatic South Asians seem to have more aggressive and diffuse arterial calcification compared to Caucasians. These differences are more profound above the age of 50, suggesting potential genetic or other risk factors yet to be determined.

Coronary artery calcification progression in asymptomatic individuals with initial score of zero.

The aim of this study is to determine the progression of coronary artery calcification (CAC) using electron beam computed tomography (CT) when the initial CAC score (CACS) is zero and to determine the best interval to repeat a CAC scan. We studied 388 individuals with zero CACS (308 males; mean age: 48.8 ± 8.26 years) who underwent 2 consecutive CT scans in a period of at least 12 months apart. The interscan period was 2.99 ± 1.35 years (range: 1-6 years). Three-quarters of the individuals (75%) did not develop any CAC progression, 20.87% presented CAC progression of 1 to 10, 3.6% had 11 to 50, whereas only 0.51% had >50. The average time of new CAC development was 4.2 ± 1.1 years. Individuals with CAC progression presented higher incidence of hypertension, diabetes mellitus, hypercholesterolaemia and higer frequency of male gender than those with without CAC changes (p<0.02). No cardiac events occurred during the follow-up period.

Differences in clinical profile of individuals with severe and markedly elevated coronary artery calcification detected by electron beam computed tomography.

Although several studies have demonstrated the association between coronary artery calcification (CAC) and coronary artery disease events, the underlying mechanism has not been fully elucidated. Furthermore, extensive CAC still remains a poorly understood phenomenon. The objective of this study is to determine the clinical characteristics and differences between 831 asymptomatic individuals with very high CAC scores (CACS ≥ 1000) and 497 asymptomatic individuals with CAC scores of 400 to 999. Individuals with CACS ≥ 1000 were more likely to have hypertension ([HTN]; P = .0004), hypercholesterolemia (P = .0001), diabetes mellitus ([DM] P = .005), and high body mass index ([BMI]; P = .03) compared with individuals with CACS = 400-999. On multivariable analysis, age (P < .0001) and BMI (P = .01) were found to be significant risk factors for the presence of very high CAC. While for males, age (P < .0001), hypercholesterolemia (P = .001), DM (P = .002), and obesity (P = .003) were independent risk factors; in females only HTN (P = .04) was independent risk factor.