Progressive Worsening in Device-Based Heart Failure Sensor Measurements are Associated with Sub-Optimal LV Pacing Percentages in CRT-D Patients

BackgroundLower %LV pacing (<98%) have been associated with significantly worse survival in a cohort of >35000 remotely monitored CRT patients. HeartLogic (HL), a heart failure (HF) composite index and alert algorithm available in both CRT-D and ICD devices, aggregates physiologic trends associated with multiple aspects of HF status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HL alerts were recently shown to detect HF events with 70% sensitivity, and identify patients with 10-fold increased risk of worsening HF.ObjectiveWe plan to investigate association between daily % LV pacing and device measured individual heart failure sensors and HeartLogic.MethodsThe ALTITUDE database collects de-identified data recorded by the implanted devices from the LATITUDE remote monitoring system. Patients with HeartLogic enabled CRT-D devices and a minimum of 30 days of daily sensor data were included. All days with AF burden were excluded. Each patient day was grouped into 6 groups based on the daily % LV pacing values (<90%, 90-91%, 92-93%, 94-95%, 96-97%, and ≥98%). For each pacing group, the mean of different device sensors, the HeartLogic index, and the proportion of days in HeartLogic alert were evaluated.ResultsOut of 2736 CRT-D patients, 594 met the selection criteria had 248 alerts over 155.13 years. Sub-optimal LV pacing percentages were associated with progressively worse device sensor values (see figure). HeartLogic index reflected significant worsening even for a small reduction in % LV pacing. The proportion of days in HeartLogic alert was about 2x higher with <90% LV pacing (19.08%; 95% CI 18.0-20.19) vs. ≥98% (11.29%; 95% CI 10.99-11.60; p<0.0001). Further, each individual sensor worsens with sub-optimal compared with optimal LV pacing.ConclusionLower %LV pacing is associated with multiple worsening heart failure sensors. This analysis provides strong evidence that the poor survival associated lower %LV pacing is likely caused by worsening heart failure. Lower %LV pacing (<98%) have been associated with significantly worse survival in a cohort of >35000 remotely monitored CRT patients. HeartLogic (HL), a heart failure (HF) composite index and alert algorithm available in both CRT-D and ICD devices, aggregates physiologic trends associated with multiple aspects of HF status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HL alerts were recently shown to detect HF events with 70% sensitivity, and identify patients with 10-fold increased risk of worsening HF. We plan to investigate association between daily % LV pacing and device measured individual heart failure sensors and HeartLogic. The ALTITUDE database collects de-identified data recorded by the implanted devices from the LATITUDE remote monitoring system. Patients with HeartLogic enabled CRT-D devices and a minimum of 30 days of daily sensor data were included. All days with AF burden were excluded. Each patient day was grouped into 6 groups based on the daily % LV pacing values (<90%, 90-91%, 92-93%, 94-95%, 96-97%, and ≥98%). For each pacing group, the mean of different device sensors, the HeartLogic index, and the proportion of days in HeartLogic alert were evaluated. Out of 2736 CRT-D patients, 594 met the selection criteria had 248 alerts over 155.13 years. Sub-optimal LV pacing percentages were associated with progressively worse device sensor values (see figure). HeartLogic index reflected significant worsening even for a small reduction in % LV pacing. The proportion of days in HeartLogic alert was about 2x higher with <90% LV pacing (19.08%; 95% CI 18.0-20.19) vs. ≥98% (11.29%; 95% CI 10.99-11.60; p<0.0001). Further, each individual sensor worsens with sub-optimal compared with optimal LV pacing. Lower %LV pacing is associated with multiple worsening heart failure sensors. This analysis provides strong evidence that the poor survival associated lower %LV pacing is likely caused by worsening heart failure.