Reply: Insights From HeartLogic Multisensor Monitoring During the COVID-19 Pandemic in New York City.

We recently described effects of the coronavirus disease-2019 (COVID-19) pandemic on health care delivery for patients with heart failure as well as the intersections between COVID-19 infection and heart failure (1). In light of increased noncontact care delivery methods for ambulatory care, telemedicine combined with the use of pulmonary artery pressure monitoring and biosensing devices can help guide heart failure management.

Dr. Mitter and colleagues describe their institutional experience with remote monitoring using HeartLogic multisensor monitoring during the COVID-19 pandemic. The HeartLogic algorithm captures information regarding heart sounds, respiration, thoracic impedance, heart rate, and activity data (2). They retrospectively reviewed data from 38 patients and found a significant decrease in activity level with only small increases in thoracic impedance. As the authors note, sedentary behavior is thought to contribute to worsening heart failure syndromes. They postulate that changes in diet and decreased autonomic tone may have contributed to their findings. While thought provoking, these data are reported from a very small sample population and are hypothesis generating. As the COVID-19 pandemic continues, larger such studies in populations of patients with heart failure and cardiac implantable electronic devices are warranted.

The COVID-19 pandemic is an opportunity for the heart failure community to incorporate more data generated by implantable monitors into routine care. Many of our patients, particularly those with systolic heart failure, have cardiac implantable electronic devices. Although HeartLogic is specific to Boston Scientific (Marlborough, Massachusetts) devices, Medtronic (Minneapolis, Minnesota) similarly has a CareLink remote monitoring network, and St. Jude Medical (St. Paul, Minnesota) has the Merlin network in addition to the implantable CardioMEMS device. These tools can provide valuable insight into patients’ activity levels, volume status, and arrhythmia burden, which could also be a trigger for worsening heart failure. These devices have limitations, and the use of intrathoracic impedance monitoring or heart rate variability from cardiac implantable electronic devices has not been demonstrated to improve clinical outcomes in large trials (3). Yet, integrating these data from remote monitoring may constructively supplement our care of patients with heart failure during the COVID-19 pandemic and beyond.

We thank Dr. Mitter and colleagues for their application of important insights from our work. Moving forward, we must continue to stay vigilant and creative to find new and effective strategies for caring for our patients with heart failure.