38
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink)

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Aims

          The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment.

          Methods

          Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink ‘on' vs. ‘off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power.

          Conclusion

          The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014.

          ClinicalTrials.gov Identifier: NCT00769457

          Related collections

          Most cited references21

          • Record: found
          • Abstract: found
          • Article: not found

          Cardiac-resynchronization therapy for the prevention of heart-failure events.

          This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30% or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Patients were randomly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator (ICD) (1089 patients) or an ICD alone (731 patients). The primary end point was death from any cause or a nonfatal heart-failure event (whichever came first). Heart-failure events were diagnosed by physicians who were aware of the treatment assignments, but they were adjudicated by a committee that was unaware of assignments. During an average follow-up of 2.4 years, the primary end point occurred in 187 of 1089 patients in the CRT-ICD group (17.2%) and 185 of 731 patients in the ICD-only group (25.3%) (hazard ratio in the CRT-ICD group, 0.66; 95% confidence interval [CI], 0.52 to 0.84; P=0.001). The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. The superiority of CRT was driven by a 41% reduction in the risk of heart-failure events, a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more. CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction. There was no significant difference between the two groups in the overall risk of death, with a 3% annual mortality rate in each treatment group. Serious adverse events were infrequent in the two groups. CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex. (ClinicalTrials.gov number, NCT00180271.) 2009 Massachusetts Medical Society
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study.

              We sought to identify whether home telemonitoring (HTM) improves outcomes compared with nurse telephone support (NTS) and usual care (UC) for patients with heart failure who are at high risk of hospitalization or death. Heart failure is associated with a high rate of hospitalization and poor prognosis. Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises. Patients with a recent admission for heart failure and left ventricular ejection fraction (LVEF) 70 years, mean LVEF was 25% (SD, 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml (interquartile range 1,285 to 6,749 pg/ml). During 240 days of follow-up, 19.5%, 15.9%, and 12.7% of days were lost as the result of death or hospitalization for UC, NTS, and HTM, respectively (no significant difference). The number of admissions and mortality were similar among patients randomly assigned to NTS or HTM, but the mean duration of admissions was reduced by 6 days (95% confidence interval 1 to 11) with HTM. Patients randomly assigned to receive UC had higher one-year mortality (45%) than patients assigned to receive NTS (27%) or HTM (29%) (p = 0.032). Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure.
                Bookmark

                Author and article information

                Journal
                Eur J Heart Fail
                eurjhf
                eurjhf
                European Journal of Heart Failure
                Oxford University Press
                1388-9842
                1879-0844
                July 2011
                8 May 2011
                8 May 2011
                : 13
                : 7
                : 796-804
                Affiliations
                [1 ]Department of Cardiology, simpleAngiology and Pneumology, Klinikum Coburg GmbH, II , Medizinische Klinik, Coburg, Germany
                [2 ]Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, simpleSaarland University Hospital , Kirrberger Strasse 1, 66424 Homburg/Saar, Germany
                [3 ]simpleKardiologische Praxis , Dessau, Germany
                [4 ]Department of Cardiology and Angiology, simpleHannover Medical School , Hannover, Germany
                [5 ]simpleHerzzentrum Brandenburg , Bernau, Germany
                [6 ]simpleKlinikum Dortmund gGmbH, Medizinische Klinik Mitte—Cardiology , Dortmund, Germany
                [7 ]Department of Internal Medicine—Herz-Kreislauf-Zentrum, simpleSegeberger Kliniken GmbH , Bad Segeberg, Germany
                [8 ]simpleKlinikum Universität München—Großhadern, Med. Klinik & Poliklinik I , München, Germany
                [9 ]Department of Internal Medicine—Cardiology and Angiology, simpleEvangelisches Krankenhaus Bielefeld , Bielefeld, Germany
                Author notes
                [* ]Corresponding author. Tel: +49 6841 1623372, Fax: +49 6841 1623369, Email: michael.boehm@ 123456uniklinikum-saarland.de (M.B.); Tel: +49 9561 226348, Fax: +49 9561 226349, Email: johannes.brachmann@ 123456klinikum-coburg.de (J.B.)
                [†]

                In memoriam.

                Article
                hfr045
                10.1093/eurjhf/hfr045
                3125124
                21555324
                0f779355-bac5-482e-9155-75cf887c9c4f
                Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissions@oup.com.

                The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 13 December 2010
                : 1 February 2011
                : 4 February 2011
                Categories
                Study Design

                Cardiovascular Medicine
                cardiac resynchronization therapy,telemedicine,implantable defibrillator,bioimpedance,disease management,chronic heart failure

                Comments

                Comment on this article