TriageHF Plus for remotely monitoring people with cardiac implantable electronic devices at risk of heart failure or worsening heart failure

The technology described in this briefing is TriageHF Plus. It is a care pathway that includes a heart failure risk score (HFRS), an online data management platform and telephone assessment. It is used to remotely monitor people at risk of heart failure or worsening heart failure. It must be used alongside Medtronic cardiac implantable electronic devices (CIEDs) and the NICE medtech innovation briefing on CareLink network service for remote monitoring of people with cardiac devices.

The innovative aspects are that, unlike other HFRSs, the TriageHF score is automated and updated every 30 days.

The intended place in therapy would be alongside standard care for people at risk of heart failure or worsening heart failure.

The main points from the evidence summarised in this briefing are from 7 studies (prospective cohort studies that include 3 full text articles and 4 conference abstracts) including a total of 2,110 adults with Medtronic CIEDs. They suggest that TriageHF Plus may be an effective care pathway for remotely monitoring people at risk of heart failure or worsening heart failure.

Key uncertainties around the evidence or technology are that all of the evidence comes from observational studies mostly done by the same research group. The lack of a concurrent control arm in any study makes it difficult to understand the impact of TriageHF Plus on patient or healthcare system outcomes. Some evidence is published in poster abstract form so detail is limited.

Experts advised that larger scale, controlled studies comparing TriageHF Plus with standard care are needed to demonstrate the claimed benefits. Multidisciplinary team involvement, training and service alignment between heart failure and cardiac physiology services is necessary for successful implementation. Additional workload burden from a large number of high‑risk alerts, as well as costs, could be a barrier for its adoption.

A safety issue identified by experts is the possibility of false-positive alerts, which could lead to unnecessary clinical contact and potential increased anxiety.

The average cost of TriageHF Plus is approximately £43 per person per year (based on an estimated average number of eligible people per centre).