Usefulness of the TRIAGE-HF Plus system for the remote monitoring of patients with heart failure

Introduction

Remote monitoring using implantable devices such as defibrillators (ICDs) and/or cardiac resynchronization therapy devices (CRT) is feasible in patients with heart failure (HF). The TriageHF Plus algorithm integrates measurements from different parameters (surrogate data of congestion, rhythm analysis, patient activity data, among others) and assigns a low, moderate, or high risk of HF decompensation within the following 30 days. Evidence regarding its feasibility and clinical impact in real-world practice is limited. Our objective was to describe the characteristics of patients with high-risk alerts, response times, clinical interventions performed, and associated clinical outcomes.

Methods

This was a single-center, retrospective, observational study that included high-risk TriageHF alerts managed between October 1, 2022, and April 30, 2025. Clinical data, interventions performed, hospitalizations, and time from alert to patient contact were collected. Alerts were reviewed daily (Monday to Friday), and a structured telephone assessment protocol was applied, followed by an in-person visit if deemed necessary (Figure 1A). HF decompensation was defined as the need for diuretic adjustment, HF-related hospitalization, and/or compatible clinical findings.

Results

Over 31 months, 230 patients were monitored, generating 253 high-risk alerts in 98 patients (1.9 alerts/week). Baseline characteristics are detailed in Table 1.

Contact was achieved in 249 alerts (98.4%), with a median delay from alert to telephone contact of 1 day (IQR 1–2). An in-person visit was performed in 82 alerts (33.3%) with a median delay of 5 days (IQR 3–11 days), while the remainder were resolved remotely.

Of all alerts, 105 (42.5%) were due to HF decompensation, while the remainder were attributable to other causes, mainly respiratory infections (Figure 1B). Twenty-nine alerts (11.7%) resulted in hospitalization for HF; 24 (9.7%) for other causes, and 19 patients (7.7%) died.

Changes in diuretic therapy were made on 93 occasions (39.4%), of which 44 (17.4%) involved intravenous diuretics. In an additional 41 alerts (17.1%), changes in neurohormonal therapy were implemented.

Conclusions

The use of TriageHF Plus is feasible, with short delays between high-risk alerts and patient assessment and a manageable workload (1.9 alerts/week). A total of 42.5% of high-risk alerts corresponded to HF decompensation, and only 11.7% required hospitalization for HF. The system enabled adjustment of diuretic therapy in nearly 40% of alerts and neurohormonal therapy in 17.4%.Table 1.For image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.