Heart monitor can predict after heart attack
In 2016, when he was still working at the Munich Ludwig-Maximilians-University, Axel Bauer – since 2019 Director of the University Clinic for Internal Medicine III in Innsbruck – explained the SMART-MI-DZHK9 study in the research network of the German Center for Cardiovascular Research (DZHK). . The results were first presented in August 2021 at the Congress of the European Society of Cardiology as part of a hotline session and have now been published by the renowned journal Lancet Digital Health.
Treat high-risk patients better in the future
The implantable monitor detected severe, mostly asymptomatic rhythm events in 60 of 201 patients within 21 months. In the control group, which consisted of 199 heart attack patients without telemonitoring, only 12 such events could be detected during the same period of time during the usual follow-up care.
“The key message is that the monitor is very sensitive to dangerous but asymptomatic rhythm events that are precursors to serious clinical events. Problems can thus be identified much earlier and high-risk patients can be better treated later,” says Bauer.
Patients who had survived a heart attack and whose cardiac output was relatively intact (ejection fraction* between 36 and 50 percent) were included in the study, but who had nerve damage to the heart caused by the heart attack. “While we implant a defibrillator as a precautionary measure in patients with an ejection fraction below 35 percent because of the high risk of arrhythmia, there are currently no specific precautionary measures for the large group of patients with an average pumping capacity,” says lead author Axel Bauer.
The heart monitor implanted under the skin is as small as a fingernail. It is a passive device that continuously records electrical information from the heart over several years. Dangerous arrhythmias are automatically detected and telemetrically transmitted to a center.
32 heart centers in Germany are taking part in the SMART-MI-DZHK9 study. The University Clinic for Internal Medicine III in Innsbruck was the only Austrian center involved. Patients in whom dangerous arrhythmias were caused by telemedicine have been treated according to current guidelines. Future studies will clarify when and to what extent this telemedicine strategy can improve the patient’s prognosis over a longer period of time.
*ejection fraction: Cardiac output markers. Ejection fraction is the amount of blood that is ejected from the left ventricle into the circulation per beat.
Characteristics
Axel Bauer has been director of the Innsbruck University Clinic for Internal Medicine III (cardiology and angiology) since 2019. One focus of his research is computer-based procedures in cardiology and sudden cardiac death. Before he was appointed to the Medical University of Innsbruck, Bauer was Medical Director of the Department of Cardiology at the inner-city hospital of the Ludwig-Maximilians-University in Munich.