#Silent passenger full
#Silent passenger trial

The population was, as expected, older and with multiple comorbidities. The report calculated daily activity and stored the data periodically into the LATITUDE (Boston Scientific Corp.) remote service. Each device had an accelerometer that picked up frequency and amount of patient motion, and if at least the equivalent of walking 2 miles/h was detected, it catalogued this as activity. ( 9) linked 28,982 patients with an implantable cardioverter-defibrillator or CRT-defibrillator between 20 and who were enrolled in the ALTITUDE (Boston Scientific Corp., Natick, Massachusetts) registry to CMS data. These investigators chose a parameter that is, without debate, linked to poor outcomes.īy using claims on inpatient and outpatient encounters, Kelly et al. Certainly, low physical activity and its relationship to poor outcomes is widely known and accepted. ( 9) in this issue of JACC: Heart Failure, who demonstrated that sudden changes in the slope of physical activity captured by the device were predictive of adverse HF outcomes (e.g., hospitalizations and death). What if the information were automatically collected, simple, predictive, and actionable? Could it be incorporated into various clinical settings and could it change practice? These important points are made by Kelly et al.

#Silent passenger full

Community practices cannot always hire additional personnel to be responsible for collecting and acting on complex data with full integration into the workflow of the office, especially without adequate insurance or Centers for Medicare & Medicaid Services (CMS) reimbursements ( 8). In addition, diagnostic algorithms and prediction models may also not be practical outside of clinical trials or specialty clinics. Monitoring alone without a systematic process of responding to the information may exceed the capabilities of primary care clinical settings. In addition, because of the ever-increasing volume of patients with HF, most patients with HF are not cared for by HF experts, or even by cardiologists, but rather by primary care providers ( 6, 7). Why then are these elements of monitoring not being used routinely in clinics? Implanters of devices are often not the providers of HF care. The investigators of these studies consistently confirmed the feasibility of monitoring and strongly recommended its use in clinical practice ( 5).

#Silent passenger trial

Although not strongly recommended by the Heart Rhythm Society Expert Consensus Statement, at least 1 randomized trial of automatic, daily, implant-based multiple parameters with remote monitoring improved outcomes for patients with HF ( 4). Combined indices can help identify early decompensation and prevent hospitalizations, as shown in the PARTNERS-HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study, which had monthly reviews of patient data ( 3). These parameters are present above the basic function of the device and represent “silent” passengers that could offer additional information. Clinical information can report volume measures by impedance, heart rate variability, abnormal autonomics, and physical activity. The growing sophistication of devices provides information for the clinician who cares for patients with HF. A large percentage of these patients had heart failure (HF) with ejection fractions (EFs) of ≤35% as the main indication, with or without dyssynchrony. Furthermore, according to the National Inpatient Sample Database, >300,000 cardiovascular resynchronization therapy (CRT) devices were implanted between 20, with 86% as CRT defibrillators ( 2). According to the National Cardiovascular Data Registry, approximately 150,000 implantable cardioverter-defibrillators are implanted annually in the United States ( 1).