Abstract 4122120: Prospective Implementation of a Cardiovascular Implantable Electronic Device Algorithm-Based Management Pathway in Routine Heart Failure Care

Introduction: More than 1 million patients in the US are hospitalized annually with heart failure (HF), many of whom have cardiovascular implantable electronic devices (CIEDs). CIEDs monitor physiologic variables that could identify subacute HF decompensation and impending HF hospitalization (HFH). One such algorithm is Medtronic’s TriageHF TM , which integrates nine diagnostic inputs from remote monitoring data to stratify patients into categories of low-, medium-, or high-risk of HFH in the next 30 days. Goals/Aims: To implement and evaluate a program in which two Veterans Health Administration (VHA) cardiology clinics receive high-risk TriageHF TM scores for patients with CIEDs, followed by contacting and assessing patients and then taking appropriate clinical action. Methods: From 1/18/24 to 4/19/24, TriageHF TM risk scores were calculated from both HF-specific remote transmissions that were scheduled every 30 days and unscheduled remote transmissions. Clinicians then contacted patients with high-risk scores regarding possible symptoms and provided an empiric 3-day diuretic intervention (initiation or dose augmentation), adjusted guideline-directed medical therapy (GDMT), or performed another clinical action as appropriate. Results: Among 358 patients with 1140 transmissions, 72 (6%) patients had a high-risk transmission. Mean patient age was 72.8 years, 346 (97%) were male, and 221 (62%) had a pre-existing diagnosis of heart failure. Of the 72 patients with high-risk transmissions, 67 (93%) were successfully contacted; 34 (51%) had no HF symptoms, 24 (36%) had mild to moderate symptoms, 2 (3%) had severe symptoms, 4 (6%) had non-HF symptoms, and 3 (4%) could not report symptoms. Of the 67, 57 (85%) reported adherence to medications and 17 (25%) were identified as likely having a non-HF related high-risk score. Forty-six (69%) had a clinical action taken in response to the high-risk score, including 28 (42%) with a diuretic intervention, 12 (18%) with GDMT augmented, and 25 (37%) with other actions, such as being referred to HF clinic. Conclusions: In this implementation study, clinicians contacted and assessed nearly all patients at high-risk for HF decompensation based on CIED remote monitoring data. Approximately 70% of patients had an actionable high-risk score, with approximately half prescribed empiric diuretics or augmented GDMT. A randomized clinical trial is needed to determine whether this algorithm and subsequent intervention improves clinical outcomes.