Clinical Utility of HeartInsight Score Variability in the Management of Patients With Heart Failure.

Background: Patients with heart failure (HF) can be monitored remotely using cardiovascular implantable electronic devices (CIEDs). In Japan, the HeartInsight algorithm has been implemented in selected implantable cardioverter defibrillators and cardiac resynchronization therapy devices. This retrospective study investigated whether elevations above, and daily fluctuations in, the HeartInsight score threshold aid prediction of hospitalization for HF. Methods: This study included 61 patients. Data were extracted from the BIOTRONIK Home Monitoring system; the number of days of HeartInsight score calculation, coefficient of variation, standard deviation, maximum value during the observation period, and mean values were analyzed. The primary endpoint was the first hospitalization for HF after CIED implantation. Patients were divided into two groups (HF hospitalization and non-HF hospitalization), and each parameter was compared between the groups. Results: The first hospitalization for HF after CIED implantation occurred in 10 of 61 patients (16%). Although the HF hospitalization group was younger than the non-HF hospitalization group, the two groups exhibited no differences in coronary risk factors, pharmacological therapies, or threshold elevation in HeartInsight scores. However, the HF hospitalization group demonstrated a tendency toward higher values, with significant differences observed in the maximum value and the difference between the maximum and mean values. Although few patients exhibited threshold elevation, greater daily variability was associated with a higher tendency toward HF hospitalization. Conclusions: Although predicting HF hospitalization based solely on threshold elevation is challenging, monitoring daily fluctuations may aid prediction. Evaluating score variability is important, even among patients without threshold elevation.