08 Oct 2021
Implantable Technology could be a game-changer for heart patients
Implantable heart technology is being used in Manchester to assess when a patient is at high risk of dying, thanks to an NIHR ARC-GM and University of Manchester led research published today.
The pacemakers and defibrillators contain multiple sensors that allow continuous monitoring of a patient’s heart health, 24 hours a day. The study published in Europace and funded by the Medical Research Council is a collaboration between The University of Manchester, Manchester University NHS Foundation Trust (MFT), Health Innovation Manchester, the National Institute for Health Applied Research Collaboration Greater Manchester (ARC-GM) and Medtronic – who manufacture implantable devices.
The research team examined remotely monitored health related data from 439 patients at Manchester Royal Infirmary over two years. The study reported a three-fold increase in odds of mortality for patients who spent at least one day in high-risk status. There was also a 26% increase in the odds of mortality for patients who had 14 consecutive days or more in a high-risk status compared with those whose high-risk episodes were shorter. Higher percentages of time spent in a high-risk status, and less time in a low-risk status, were also associated with increased risk of death.
The researchers are currently investigating if integration of the remotely monitored device data into healthcare pathways can reduce hospitalisations and mortality.
Dr Fozia Ahmed, Honorary Reader in Cardiovascular Sciences from The University of Manchester and MRI cardiologist said: “Remote monitoring capabilities of modern day cardiac devices enables continuous monitoring of health-related data in the patient’s own home. The data can help identify when there is a potentially significant shift in a patient’s clinical condition, helping to predict future adverse clinical events, such as hospitalisation and death.
“Historically cardiologists have seen patients at 6-12 month hospital-based appointments. If a patient with heart failure is unwell between appointments, then we rely on the patient getting in touch. But data suggests this approach is less than effective- patients don’t always know they are unwell until it is too late.
“We believe this technology could be a game-changer in the management of cardiac patients, particularly those with heart failure. In Greater Manchester, based on the data from the research, we have started to use the device-derived alerts, which notify the care team when a patient is detected by the device as ‘high-risk’, prompting a telephone consultation with a specialist. The whole process from detection of a high-risk episode, through to assessment and follow-up is known as the TriageHF Plus care pathway- originally developed in Manchester, it is now being used more widely.”
Dr Camilla Sammut-Powell, from the National Institute for Health Applied Research Collaboration Greater Manchester (NIHR ARC-GM) at The University of Manchester and lead statistician for the research said: “This is the first prospective study to show that remotely monitored Cardiovascular Implantable Electronic Device data, summarised as a risk score, can be used to predict mortality. This routinely monitored data, automatically collected every day, can help discriminate between patients at high and low risk of death. Such information may personalise a clinician’s decision making towards ensuring that the patient is in receipt of therapies designed to improve their long-term prognosis.”
Medtronic, industry collaborators who manufacture the device said: “The increased mortality identified in the evaluation justified the need for an Industry-NHS collaboration in this space, to create a digital solution to that aims to ensure that the high risk notifications are sent direct to heart care teams who can take action as clinically indicated, based on the health-related data from the patient’s device and patient reported symptoms”.
The researchers, with support from the National Institute for Health Applied Research Collaboration Greater Manchester (NIHR ARC-GM), are undertaking a follow on study to evaluate the costs and resources of implementing the new heart failure care pathway.