key: cord-0988151-vl2gjxju
authors: DeFilippis, Ersilia M.; Reza, Nosheen; Jessup, Mariell
title: Reply: Insights into Heart Failure from Cardiac Implantable Electronic Devices During the COVID-19 Pandemic
date: 2020-10-13
journal: JACC Heart Fail
DOI: 10.1016/j.jchf.2020.10.001
sha: f43eea30baa3b2faf50ca9851dfe57102dd827ba
doc_id: 988151
cord_uid: vl2gjxju

nan

We recently described effects of the COVID-19 pandemic on health care delivery for patients with heart failure as well as the intersections between COVID-19 infection and heart failure (1).

In light of increased noncontact care delivery methods for ambulatory care, telemedicine combined with the use of pulmonary artery pressure monitoring and biosensing devices can help guide heart failure management.

Dr. Mitter and colleagues describe their institutional experience with remote monitoring using HeartLogic Multi-sensor monitoring during the COVID-19 pandemic (2) . The HeartLogic algorithm captures information regarding heart sounds, respiration, thoracic impedance, heart rate, and activity data (3). They retrospectively reviewed data from thirty-eight patients and found a significant decrease in activity level with only small increases in thoracic impedance. As the authors note, sedentary behavior is thought to contribute to worsening heart failure syndromes. They postulate that changes in diet and decreased autonomic tone may have contributed to their findings. While thought-provoking, these data are reported from a very small sample population and are hypothesis-generating. As the COVID-19 pandemic continues, larger such studies in populations of patients with heart failure and cardiac implantable electronic devices are warranted.

The COVID-19 pandemic is an opportunity for the heart failure community to incorporate more data generated by implantable monitors into routine care. Many of our patients, particularly with systolic heart failure, have cardiac implantable electronic devices. While HeartLogic is specific to Boston Scientific devices, Medtronic similarly has a CareLink remote monitoring network and St. Jude has the Merlin network in addition to the implantable CardioMEMS device. These tools can provide valuable insight into patients' activity levels, volume status, as well as arrhythmia burden which could also be a trigger for worsening heart failure. These devices have limitations and the use of intrathoracic impedance monitoring or heart rate variability from cardiac implantable electronic devices have not been demonstrated to improve clinical outcomes in large trials (4) . Yet, integrating these data from remote monitoring may be able to constructively supplement our care of patients with heart failure during the COVID-19 pandemic and beyond.

J o u r n a l P r e -p r o o f

Considerations for Heart Failure Care During the COVID-19 Pandemic

Letter to the Editor: Insights from HeartLogic Multi-sensor Monitoring during the COVID-19 Pandemic

HeartLogic Multisensor Algorithm Identifies Patients During Periods of Significantly Increased Risk of Heart Failure Events: Results From the MultiSENSE Study

Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors

We thank Mitter and colleagues for their application of important insights from our work.Moving forward, we must continue to stay vigilant and creative to find new and effective strategies for caring for our patients with heart failure.