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HeartLogic Allows Intense Remote Monitoring of Patient After Implantation of VIGILANT™ CRT-D

Summary

 
test

Age and Gender: 68-year-old female

Device Used: VIGILANT™ CRT-D

Patient History: Dilated cardiomyopathy, severe mitral regurgitation, second-degree heart block (HB) and left bundle branch block (LBBB). Six days prior to implant, patient presented in emergency department with symptoms of malaise/fatigue, dyspnea on exertion and shortness of breath.

  • LHC/RHC due to severe heart failure (HF)
  • Vitals:
    • HR 48
    • BP 123/74
    • RR 18 O2 Sat 89% (6L nasal cannula)
    • Weight 63kg (139lb)
  • Admitted for 25 days

Timeline Prior to Alert:

Day 1: VIGILANT CRT-D Implanted

Day 12: Patient continues to have volume overload secondary to Acute/Chronic HF IV treatment:

  • Furosemide (LASIX®) infuse 5mg/hr
  • Milrinone (PRIMACOR®) infuse 23.1375 mcg/min

Day 21: Discharged 

  • ACC/AHA stage D heart failure

Cardiac Medications:

  • Lisinopril 10mg BID – reduced from 30mg qd
  • Metoprolol (TOPROL-XL®) 100mg daily - increase from baseline
  • ALDACTONE® 25mg daily – new

Day 34: Follow-up with CHF Clinic and Device Clinic

  • Start PRN diuretic Demadex® 10mg daily
    • Standard protocol for this clinic

(A) Day 42: HeartLogic Alert Level 17

Home Health RN:

  • Reports fever and non-productive cough

Medication Change:

  • None

(B) Day 49: Alert Level 50

Home Health RN:

  • Weight Assessment +2 lb gain
  • Patient has SOB and edema

Medication Change:

  • Demadex® 10mg x 1 per protocol

(C) Day 58: Alert Level 56

  • Patient has edema and SOB
  • Demadex® 10mg M W F

(D) Day 63: Alert Level 58

Nurse Practitioner Visit:

  • +3 lb weight gain
  • Demadex® 10mg daily

(E) Day 98: Alert Level 16

  • Lisinopril Discontinued
  • Entresto® 49/51mg started

(F) Day 104: Alert Level 0

  • No SOB or edema noted
  • Patient states “I’m feeling much better and have started walking around the block again”
  • Continue remote monitoring with HeartLogic

 

 

Clinical Data

 

HeartLogic™ Heart Failure Index

Day 108
 

Contributing Trends

Note: Shaded portion indicates degree of worsening on Day 56.

trend chart

 

 

contributing trends

(A) Day 42: Alert Level 17

Home Health RN:

  • Reports fever and non-productive cough
  • Patient ER visit; discharged with non-productive cough

Medication Change:

  • None
  • BNP = 1,236
  • Previous BNP = 2,272 (5 months earlier)

(B) Day 49: Alert Level 50

Home Health RN:

  • Weight Assessment
  • Weight = 124.35 lbs
  • Patient has SOB and edema

Medication Change:

  • Demadex® 10mg x 1 per protocol

HeartLogicTM Heart Failure Index

date
 

Contributing Trends

Note: Shaded portion indicates degree of worsening on Day 56.

trend graph

 

 

contributing trends

(C) Day 58: Alert Level 56

  • Patient has edema and SOB
  • Demadex® 10mg M W F

(D) Day 63: Alert Level 58

Nurse Practitioner Visit:

  • Weight = 127 pounds
  • Demadex® 10mg daily

(E) Day 98: Alert Level 16

  • Weight = 127 pounds
  • Lisinopril Discontinued
  • Entresto® 49/51mg started

(F) Day 104: Alert Level 0

Patient will continue to follow-up with CHF Clinic and Device Clinic

  • May 22 – Office visit with CHF clinic
  • Weight = 124lbs
  • No SOB or edema noted
  • Patient states “I’m feeling much better and have started walking around the block again”
  • Continue remote monitoring with HeartLogic
trend chart
trend chart

     S3

S1 chart

     S1

thoracic impedence

     Thoracic Impedence

respiratory rate

     Respiratory Rate

Night heart rate

     Night Heart Rate

sleep incline

     Sleep Incline

weight

     Activity Level

Blood pressure

     AT/AF Burden

HeartLogic Trend Graph for V Therapy

     V Therapy

HeartLogic Trend Graph for Mean Heart Rate

     Mean Heart Rate

HeartLogic Trend Graph for Heart Rate Variability (SDANN)

     Heart Rate Variability (SDANN)

LATITUDE® Patient Management - Heart Failure Management Report

LATITUDE Patient Management Heart Failure Management Report
LATITUDE Patient Management Heart Failure Management Report
 

Next Steps

 

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Results from the case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
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