{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:44:51Z","timestamp":1793810691652,"version":"4.6.1"},"reference-count":24,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005035","name":"Biotronik","doi-asserted-by":"publisher","award":["D-12359"],"award-info":[{"award-number":["D-12359"]}],"id":[{"id":"10.13039\/501100005035","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,6,10]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The alert-based HeartInsight algorithm predicts risk of worsening heart failure hospitalisations (WHFHs) by evaluating temporal trends of seven physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators. The aim of the present study was to evaluate the predictive performance of HeartInsight in a larger and more heterogeneous meta-cohort of patients, incorporating newer device generations and including patients managed with the most recent guideline-directed medical therapy (GDMT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The HeartInsight algorithm was retrospectively applied to data from four clinical trials in which WHFH events were adjudicated by independent external boards and remote monitoring was activated to provide relevant parameter trends. The analysis comprised 1352 patients with New York Heart Association (NYHA) class II\/III, and no long-standing atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow-up of 599 days, 110 patients (median age 68 years (IQR, 61\u201375), 75.7% male) had a total of 165 WHFHs. The estimated sensitivity of WHFH prediction, as determined by generalised estimating equations, was 51.5% (95% CI 43.0% to 59.9%). The false alert rate was 0.85 per patient-year, the median alerting time was 34 days (IQR, 16\u201378) and the specificity was 81.4% (95% CI 80.4 to 82.4%). The results were verified in the multivariable analysis with two adjusting covariates (newer\/older device generation and quadruple\/other GDMT) and in the univariable analysis of prespecified patient subgroups according to NYHA class, aetiology and sex, showing no significant differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Study results underscore the robustness of the predictive algorithm in a heterogeneous and contemporarily managed heart failure population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003474","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T02:57:07Z","timestamp":1752548227000},"page":"e003474","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating an alert-based multiparametric algorithm for predicting heart failure hospitalisations in patients with implantable cardioverter-defibrillators: a meta-cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-207X","authenticated-orcid":false,"given":"Alan","family":"Bulava","sequence":"first","affiliation":[{"name":"Ceske Budejovice Hospital, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"De Sousa","sequence":"additional","affiliation":[{"name":"Cardiology, Unidade Local de Sa\u00fade de Santa Maria, EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Gu\u00e9don-Moreau","sequence":"additional","affiliation":[{"name":"CHU Lille, Lille University Hospital Center, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morio","family":"Shoda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Timmel","sequence":"additional","affiliation":[{"name":"BIOTRONIK SE & Co KG, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally Thompson","family":"Hilpert","sequence":"additional","affiliation":[{"name":"BIOTRONIK SE & Co KG, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"D\u2019Onofrio","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"2026010701102722000_12.2.e003474.1","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1001\/jamacardio.2019.0766","article-title":"Trends in Readmissions and Length of Stay for Patients Hospitalized With Heart Failure in Canada and the United States","volume":"4","author":"Samsky","year":"2019","journal-title":"JAMA Cardiol"},{"key":"2026010701102722000_12.2.e003474.2","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1002\/ehf2.13155","article-title":"Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event","volume":"8","author":"Givertz","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026010701102722000_12.2.e003474.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.25"},{"key":"2026010701102722000_12.2.e003474.4","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/europace\/euab170","article-title":"Combining home monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study","volume":"24","author":"D\u2019Onofrio","year":"2022","journal-title":"EP Europace"},{"key":"2026010701102722000_12.2.e003474.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.584102"},{"key":"2026010701102722000_12.2.e003474.6","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad061","article-title":"Ability to remotely monitor atrial high-rate episodes using a single-chamber implantable cardioverter-defibrillator with a floating atrial sensing dipole","volume":"25","author":"Hindricks","year":"2023","journal-title":"Europace"},{"key":"2026010701102722000_12.2.e003474.7","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae032","article-title":"Predicting worsening heart failure hospitalizations in patients with implantable cardioverter defibrillators: is it all about alerts? A pooled analysis of nine trials","volume":"26","author":"Botto","year":"2024","journal-title":"Europace"},{"key":"2026010701102722000_12.2.e003474.8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2026010701102722000_12.2.e003474.9","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1002\/ejhf.2644","article-title":"Trajectories in New York Heart Association functional class in heart failure across the ejection fraction spectrum: data from the Swedish Heart Failure Registry","volume":"24","author":"Lindberg","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026010701102722000_12.2.e003474.10","first-page":"147","article-title":"Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure","volume":"10","author":"Zeitler","year":"2022","journal-title":"JACC: Heart Failure"},{"key":"2026010701102722000_12.2.e003474.11","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.hrthm.2017.08.021","article-title":"Profound differences in prognostic impact of left ventricular reverse remodeling after cardiac resynchronization therapy relate to heart failure etiology","volume":"15","author":"Martens","year":"2018","journal-title":"Heart Rhythm"},{"key":"2026010701102722000_12.2.e003474.12","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.013485","article-title":"Sex-Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation","volume":"8","author":"Leyva","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2026010701102722000_12.2.e003474.13","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/pace.14443","article-title":"Impact of lockdown during COVID\u201019 pandemic on physical activity and arrhythmia burden in heart failure patients","volume":"45","author":"Schmitt","year":"2022","journal-title":"Pacing Clinical Electrophis"},{"key":"2026010701102722000_12.2.e003474.14","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/europace\/euae233","article-title":"Comprehensive vs. standard remote monitoring of cardiac resynchronization devices in heart failure patients: results of the ECOST-CRT study","volume":"26","author":"Klein","year":"2024","journal-title":"Europace"},{"key":"2026010701102722000_12.2.e003474.15","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0140-6736(14)61176-4","article-title":"Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial","volume":"384","author":"Hindricks","year":"2014","journal-title":"The Lancet"},{"key":"2026010701102722000_12.2.e003474.16","first-page":"976","article-title":"Alert-Based ICD Follow-Up","volume":"7","author":"Varma","year":"2021","journal-title":"JACC: Clinical Electrophysiology"},{"key":"2026010701102722000_12.2.e003474.17","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/ehjdh\/ztac016","article-title":"A clinician\u2019s guide to understanding and critically appraising machine learning studies: a checklist for Ruling Out Bias Using Standard Tools in Machine Learning (ROBUST-ML)","volume":"3","author":"Al-Zaiti","year":"2022","journal-title":"Eur Heart J Digit Health"},{"key":"2026010701102722000_12.2.e003474.18","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/ehjdh\/ztac025","article-title":"Applications of artificial intelligence and machine learning in heart failure","volume":"3","author":"Averbuch","year":"2022","journal-title":"Eur Heart J Digit Health"},{"key":"2026010701102722000_12.2.e003474.19","first-page":"216","article-title":"A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices","volume":"5","author":"Boehmer","year":"2017","journal-title":"JACC: Heart Failure"},{"key":"2026010701102722000_12.2.e003474.20","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000767"},{"key":"2026010701102722000_12.2.e003474.21","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1002\/ejhf.2874","article-title":"Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology","volume":"25","author":"Metra","year":"2023","journal-title":"European J of Heart Fail"},{"key":"2026010701102722000_12.2.e003474.22","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.amjmed.2019.06.040","article-title":"Prior Heart Failure Hospitalization and Outcomes in Patients with Heart Failure with Preserved and Reduced Ejection Fraction","volume":"133","author":"Malik","year":"2020","journal-title":"Am J Med"},{"key":"2026010701102722000_12.2.e003474.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.049"},{"key":"2026010701102722000_12.2.e003474.24","doi-asserted-by":"crossref","first-page":"C337","DOI":"10.1093\/eurheartjsupp\/suad030","article-title":"HeartInsight: from SELENE HF to implementation in clinical practice","volume":"25","author":"Zanotto","year":"2023","journal-title":"Eur Heart J Suppl"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003474","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:10:37Z","timestamp":1767777037000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,7,8]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/openhrt-2025-003474"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003474","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}