title: Comparison of partners-heart failure algorithm vs care alert in remote heart failure management.
abstract: OBJECTIVE
  To compare the utility of the partners-heart failure (HF) algorithm with the care alert strategy for remote monitoring, in guiding clinical actions oriented to treat impending HF.
  
  
  METHODS
  Consecutive cardiac resynchronization-defibrillator recipients were followed with biweekly automatic transmissions. After every transmission, patients received a phone contact in order to check their health status, eventually followed by clinical actions, classified as "no-action", "non-active" and "active". Active clinical actions were oriented to treat impending HF. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of the partners-HF algorithm vs care alert in determining active clinical actions oriented to treat pre-HF status and to prevent an acute decompensation, were also calculated.
  
  
  RESULTS
  The study population included 70 patients with moderate to advanced systolic HF and QRS duration longer than 120 ms. During a mean follow-up of 8 ± 2 mo, 665 transmissions were collected. No deaths or HF hospitalizations occurred. The sensitivity and specificity of the partners-HF algorithm for active clinical actions oriented to treat impending HF were 96.9% (95%CI: 0.96-0.98) and 92.5% (95%CI: 0.90-0.94) respectively. The positive and negative predictive values were 84.6% (95%CI: 0.82-0.87) and 98.6% (95%CI: 0.98-0.99) respectively. The partners-HF algorithm had an accuracy of 93.8% (95%CI: 0.92-0.96) in determining active clinical actions. With regard to active clinical actions, care alert had a sensitivity and specificity of 11.05% (95%CI: 0.09-0.13) and 93.6% respectively (95%CI: 0.92-0.95). The positive predictive value was 42.3% (95%CI: 0.38-0.46); the negative predictive value was 71.1% (95%CI: 0.68-0.74). Care alert had an accuracy of 68.9% (95%CI: 0.65-0.72) in determining active clinical actions.
  
  
  CONCLUSIONS
  The partners-HF algorithm proved higher accuracy and sensitivity than care alert in determining active clinical actions oriented to treat impending HF. Future studies in larger populations should evaluate partners-HF ability to improve HF-related clinical outcomes.
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calo'
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Martino
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Tota
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fagagnini
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Iulianella
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rebecchi
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sciarra
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giunta
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Romano
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Colaceci
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciccaglioni
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ammirati
authors.affiliation: Leonardo Calo', Annamaria Martino, Claudia Tota, Alessandro Fagagnini, Renzo Iulianella, Marco Rebecchi, Luigi Sciarra, Ermenegildo de Ruvo, Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy.
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: de Ruvo
keywords: Cardiac resynchronization therapy; Defibrillators; Heart failure; Remote monitoring