AIMS: To predict worsening heart failure hospitalizations (WHFHs) in patients with implantable defibrillators and remote monitoring, the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24 h heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity, and thoracic impedance. We compared temporal trends of the HF score and its components 12 weeks before a WHFH with 12-week trends in patients without WHFH, to assess whether trends indicate deteriorating HF regardless of alert status. METHODS AND RESULTS: Data from nine clinical trials were pooled, including 2050 patients with a defibrillator capable of atrial sensing, ejection fraction ≤ 35%, NYHA class II/III, no long-standing atrial fibrillation, and 369 WHFH from 259 patients. The mean HF score was higher in the WHFH group than in the no WHFH group (42.3 ± 26.1 vs. 30.7 ± 20.6, P < 0.001) already at the beginning of 12 weeks. The mean HF score further increased to 51.6 ± 26.8 until WHFH (+22% vs. no WHFH group, P = 0.003). As compared to the no WHFH group, the algorithm components either were already higher 12 weeks before WHFH (24 h HR, HR variability, thoracic impedance) or significantly increased until WHFH (nocturnal HR, atrial tachyarrhythmia, ventricular extrasystoles, patient activity). CONCLUSION: The HF score was significantly higher at, and further increased during 12 weeks before WHFH, as compared to the no WHFH group, with seven components showing different behaviour and contribution. Temporal trends of HF score may serve as a quantitative estimate of HF condition and evolution prior to WHFH.

Cardiothoracovascular Department Cattinara Hospital ASUGI and University of Trieste Trieste Italy

Center for Clinical Research Biotronik SE and Co KG Berlin Germany

CHU Lille University of Lille Lille University Hospital Center Lille Hauts de France France

Clinical Unit Biotronik Italia S P A Cologno Monzese Italy

Faculty of Health and Social Sciences Ceske Budejovice Hospital University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech Republic

U O Electrophysiology ASST Rhodense 95 Viale Carlo Forlanini 20024 Garbagnate Milanese Italy

Unità Operativa di Elettrofisiologia Studio e Terapia delle Aritmie Monaldi Hospital Naples Italy

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Evaluating an alert-based multiparametric algorithm for predicting heart failure hospitalisations in patients with implantable cardioverter-defibrillators: a meta-cohort study