Effect of remote monitoring on the management of heart failure patients with cardiac amyloidosis

Abstract Objective The primary objective was to assess the characteristics of heart failure (HF) patients with cardiac amyloidosis (CA) monitored remotely with our program. The secondary objective was to evaluate the discrimination of alerts by remote monitoring for HF in this specific population. Methods The entire multicentre cohort of HF patients monitored remotely with our program from August 2018 to December 2023 were included in the analysis. Results A total of 13,933 patients, including 346 (2.5%) with CA and 13,587 (97.5%) without cardiac amyloidosis (no-CA), had a median follow-up of 14 months. CA patients were more often male (78.6% vs 63.8%), over 80 years of age (69.9% vs 40.4%), with left ventricular ejection fraction >40% (78.6% vs 56.5%), more often NYHA class III-IV (26.6% vs 16.2%), more atrial fibrillation (54.0% vs 40.9%) but less myocardial infarction (8.4% vs 27.9%), diabetes (16.5% vs 28.1%), smoking (2.9% vs 13.4%), p<0.001 for all. There was no difference in the rate of renal failure (21.7% vs. 20.3%), obstructive sleep apnea (15.9% vs. 14.9%) or stroke (10.7% vs. 9.4%). Remote monitoring identified a total of 57,624 alerts, including 1240 in the CA group vs 56,384 in the no-CA group (i.e. 3.58 alerts per CA patient vs 4.15 alerts per no-CA patient). Of the alert resolutions in the CA group vs no-CA group, 22.4% vs 38.9% had a low probability of cardiac decompensation, 34.0% vs 35.4% had a moderate probability, 43.6% vs 25.7% had a high probability of cardiac decompensation (global Chi-square p<0.001). Conclusion Despite an elderly population with different comorbidities, remote monitoring with this program in CA patients identifies correct relevance for discrimination of cardiac decompensation.