DOI: 10.1161/circ.148.suppl_1.14302 ISSN: 0009-7322

Abstract 14302: Heart Logic Directed Uptitration of Guideline Directed Medical Therapy Improves EF Across All Device Categories

Robert A Pickett, Elizabeth Shannon, Daniel W Kaiser, Jonathan Gandhi, Ricardo M Lugo
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Historically data for CHF management in ICD patients had been for adjustments in diuretics. GDMT changes are often limited due to BP, renal function, or concerns for hypotension.

Hypothesis: Using the Heart Logic score on Boston Scientific ICDs we could up-titrate GDMT in a safe reliable fashion which would allow for further improvement in LVEF and avoid complications.

Methods: 30 patients with either a new implant or generator change (single, dual, or resynchronization) with a compatible ICD were enrolled. The alert threshold was lowered from the standard of 16 to 10. The goal was to identify patients before congestion occurred. All patients were followed with remote monitoring. When an alert occurred, a single class of GDMT was increased. If alert did not go back to zero on repeat transmission, then a second class of medicine was up-titrated, changed, or added. The patients were followed for one year with yearly echo.

Results: 30 patients were enrolled. 2 died during the year follow-up from end stage CHF after being turned down for transplant or MCS. 1 patient did not have a one year follow-up echo. A total of 47 medicine changes or up-titrations were made. The average EF improved from baseline 27.5% to 37.2%. There were no syncopal events, worsening renal function, or hyperkalemia reported. The only subjective complaints were transient dizziness.

Conclusions: Heart Logic based medication management allows a safe mechanism for increase or change in GDMT in the CHF population. Up-titration is necessary for better outcomes in CHF care but is also often limited to subjective concerns regarding potential complications.

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