PMID- 28299615
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 1092-8464 (Print)
IS  - 1092-8464 (Linking)
VI  - 19
IP  - 3
DP  - 2017 Mar
TI  - Remote Monitoring in Heart Failure: the Current State.
PG  - 22
LID - 10.1007/s11936-017-0519-5 [doi]
AB  - The treatment of congestive heart failure is an expensive undertaking with much 
      of this cost occurring as a result of hospitalization. It is not surprising that 
      many remote monitoring strategies have been developed to help patients maintain 
      clinical stability by avoiding congestion. Most of these have failed. It seems 
      very unlikely that these failures were the result of any one underlying false 
      assumption but rather from the fact that heart failure is a progressive, deadly 
      disease and that human behavior is hard to modify. One lesson that does stand out 
      from the myriad of methods to detect congestion is that surrogates of congestion, 
      such as weight and impedance, are not reliable or actionable enough to influence 
      outcomes. Too many factors influence these surrogates to successfully and 
      confidently use them to affect HF hospitalization. Surrogates are often 
      attractive because they can be inexpensively measured and followed. They are, 
      however, indirect estimations of congestion, and due to the lack specificity, the 
      time and expense expended affecting the surrogate do not provide enough benefit 
      to warrant its use. We know that high filling pressures cause transudation of 
      fluid into tissues and that pulmonary edema and peripheral edema drive patients 
      to seek medical assistance. Direct measurement of these filling pressures appears 
      to be the sole remote monitoring modality that shows a benefit in altering the 
      course of the disease in these patients. Congestive heart failure is such a 
      serious problem and the consequences of hospitalization so onerous in terms of 
      patient well-being and costs to society that actual hemodynamic monitoring, 
      despite its costs, is beneficial in carefully selected high-risk patients. Those 
      patients who benefit are ones with a prior hospitalization and ongoing New York 
      Heart Association (NYHA) class III symptoms. Patients with NYHA class I and II 
      symptoms do not require hemodynamic monitoring because they largely have normal 
      hemodynamics. Those with NYHA class IV symptoms do not benefit because their 
      hemodynamics are so deranged that they cannot be substantially altered except by 
      mechanical circulatory support or heart transplantation. Finally, hemodynamic 
      monitoring offers substantial hope to those patients with normal ejection 
      fraction (EF) heart failure, a large group for whom medical therapy has largely 
      been a failure. These patients have not benefited from the neurohormonal 
      revolution that improved the lives of their brothers and sisters with reduced 
      ejection fractions. Hemodynamic stabilization improves the condition of both but 
      more so of the normal EF cohort. This is an important observation that will help 
      us design future trials for the 50% of heart failure patients with normal 
      systolic function.
FAU - Mohan, Rajeev C
AU  - Mohan RC
AD  - Advanced Heart Failure and Mechanical Circulatory Support Program, Pulmonary 
      Hypertension Program, Division of Cardiology, Scripps Clinic, 9898 Genesee 
      Avenue, AMP Suite #300, La Jolla, CA, 92037, USA. Mohan.rajeev@scrippshealth.org.
FAU - Heywood, J Thomas
AU  - Heywood JT
AD  - Advanced Heart Failure and Mechanical Circulatory Support Program, Pulmonary 
      Hypertension Program, Division of Cardiology, Scripps Clinic, 9898 Genesee 
      Avenue, AMP Suite #300, La Jolla, CA, 92037, USA.
FAU - Small, Roy S
AU  - Small RS
AD  - Cardiology, Lancaster Heart and Vascular Institute, Lancaster General 
      Hospital/Penn Medicine, Lancaster, PA, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Treat Options Cardiovasc Med
JT  - Current treatment options in cardiovascular medicine
JID - 9815942
OTO - NOTNLM
OT  - Heart failure
OT  - Hemodynamic monitoring
OT  - Remote monitoring
OT  - Telemonitoring
EDAT- 2017/03/17 06:00
MHDA- 2017/03/17 06:01
CRDT- 2017/03/17 06:00
PHST- 2017/03/17 06:00 [entrez]
PHST- 2017/03/17 06:00 [pubmed]
PHST- 2017/03/17 06:01 [medline]
AID - 10.1007/s11936-017-0519-5 [pii]
AID - 10.1007/s11936-017-0519-5 [doi]
PST - ppublish
SO  - Curr Treat Options Cardiovasc Med. 2017 Mar;19(3):22. doi: 
      10.1007/s11936-017-0519-5.