HeartLogic Allows Intense Remote Monitoring of Patient After Implantation of VIGILANT™ CRT-D

Summary

Age and Gender: 68-year-old female

Device Used: VIGILANT™ CRT-D

Patient History: Dilated cardiomyopathy, severe mitral regurgitation, second-degree heart block (HB) and left bundle branch block (LBBB). Six days prior to implant, patient presented in emergency department with symptoms of malaise/fatigue, dyspnea on exertion and shortness of breath.

• LHC/RHC due to severe heart failure (HF)
• Vitals:
  • HR 48
  • BP 123/74
  • RR 18 O2 Sat 89% (6L nasal cannula)
  • Weight 63kg (139lb)
• Admitted for 25 days

Timeline Prior to Alert:

Day 1: VIGILANT CRT-D Implanted

Day 12: Patient continues to have volume overload secondary to Acute/Chronic HF IV treatment:

• Furosemide (LASIX®) infuse 5mg/hr
• Milrinone (PRIMACOR®) infuse 23.1375 mcg/min

Day 21: Discharged 

• ACC/AHA stage D heart failure

Cardiac Medications:

• Lisinopril 10mg BID – reduced from 30mg qd
• Metoprolol (TOPROL-XL®) 100mg daily - increase from baseline
• ALDACTONE® 25mg daily – new

Day 34: Follow-up with CHF Clinic and Device Clinic

• Start PRN diuretic Demadex® 10mg daily
  • Standard protocol for this clinic
    

(A) Day 42: HeartLogic Alert Level 17

Home Health RN:

• Reports fever and non-productive cough

Medication Change:

• None
  

(B) Day 49: Alert Level 50

Home Health RN:

• Weight Assessment +2 lb gain
• Patient has SOB and edema
  

Medication Change:

• Demadex® 10mg x 1 per protocol

(C) Day 58: Alert Level 56

• Patient has edema and SOB
• Demadex® 10mg M W F

(D) Day 63: Alert Level 58

Nurse Practitioner Visit:

• +3 lb weight gain
• Demadex® 10mg daily
  

(E) Day 98: Alert Level 16

• Lisinopril Discontinued
• Entresto® 49/51mg started

(F) Day 104: Alert Level 0

• No SOB or edema noted
• Patient states “I’m feeling much better and have started walking around the block again”
• Continue remote monitoring with HeartLogic
  

Clinical Data

HeartLogic™ Heart Failure Index

(A) Day 42: Alert Level 17

Home Health RN:

• Reports fever and non-productive cough
• Patient ER visit; discharged with non-productive cough

Medication Change:

• None
  
• BNP = 1,236
• Previous BNP = 2,272 (5 months earlier)

(B) Day 49: Alert Level 50

Home Health RN:

• Weight Assessment
• Weight = 124.35 lbs
• Patient has SOB and edema
  

Medication Change:

• Demadex® 10mg x 1 per protocol

HeartLogic^TM Heart Failure Index

(C) Day 58: Alert Level 56

• Patient has edema and SOB
• Demadex® 10mg M W F

(D) Day 63: Alert Level 58

Nurse Practitioner Visit:

• Weight = 127 pounds
• Demadex® 10mg daily

(E) Day 98: Alert Level 16

• Weight = 127 pounds
  
• Lisinopril Discontinued
  
• Entresto® 49/51mg started

(F) Day 104: Alert Level 0

Patient will continue to follow-up with CHF Clinic and Device Clinic

• May 22 – Office visit with CHF clinic
• Weight = 124lbs
• No SOB or edema noted
  
• Patient states “I’m feeling much better and have started walking around the block again”
• Continue remote monitoring with HeartLogic
  

Explore More Case Studies