Device diagnostics and early identification of acute decompensated heart failure: a systematic review.
BACKGROUND
Traditional methods of heart failure (HF) management are based on reactive strategies to treat late indicators of decompensated HF. Advances in monitoring methods have become available with the evolution of implantable cardioverter-defibrillators and cardiac-resynchronization therapy devices. These devices provide new diagnostic data and remote monitoring capabilities that allow clinicians to proactively monitor patients for earlier signs of worsening HF. The integration of data obtained from implantable cardioverter-defibrillator and cardiac-resynchronization therapy technology could improve outpatient HF care, potentially leading to decreased readmission rates and improved patient outcomes.


OBJECTIVE
This review will synthesize the literature regarding the efficacy of device diagnostic data and the usability of the data in the clinical setting.


METHODS
Articles for review were obtained using Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, and ClinicalTrials.gov.


RESULTS
Device diagnostics showed strong correlation with established HF biomarkers and hemodynamic measures. The findings from this review indicate that device diagnostic parameters predict impending HF much earlier than traditional methods of monitoring do. Device diagnostics are also more accurate in the early prediction of HF when compared with noninvasive objective measures, particularly when multiple parameters are combined and monitored for trends. Device diagnostics possess a distinct advantage over traditional methods of monitoring for HF because they allow clinicians to remotely monitor the status of their HF patients without relying on patient compliance for data entry and reporting.


CONCLUSIONS
Studies regarding the efficacy of device diagnostic parameters suggest that their integration into clinical practice will provide a more accurate and reliable mechanism for assisting clinicians in risk stratifying and predicting potential episodes of decompensated HF.
Tara Leslie Blair, RN, DNP, CHFN Doctoral Graduate, College of Nursing, University of Kentucky, and Clinical Nurse Specialist, Saint Joseph Hospital, Lexington, Kentucky.
Tara Leslie
TL
Blair
D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D011379:Prognosis; D018570:Risk Assessment