Peter Simon Macdonald

Introduction: Subcutaneous implantable cardioverter defibrillators (S‐ICD) are an alternative to transvenous devices (TV‐ICD) in patients not requiring bradycardia pacing, resynchronization (CRT) or anti‐tachycardia pacing (ATP). At our center, S‐ICDs are often preferred in patients being considered for heart transplantation (HTx) without pacing/CRT/ATP needs, as their removal post‐HTx avoids retained transvenous leads which can preclude MRI surveillance for graft rejection. We assessed outcomes of S‐ICDs in this population. Methods: We retrospectively reviewed 201 S‐ICD implants at our center; July 2016 ‐ March 2025. Results: We identified 33 patients (22 male; age 46 ± 13 years) who, at time of S‐ICD implant, had been referred for HTx evaluation or were referred at any time thereafter. Etiologies were nonischemic cardiomyopathy ( n = 18), hypertrophic cardiomyopathy ( n = 5), ischemic cardiomyopathy ( n = 4), congenital heart disease ( n = 4), and myocarditis ( n = 2). Median follow‐up was 296 days [IQR = 72–798]. Two patients died, both non‐arrhythmic. Four patients received appropriate S‐ICD therapies and three had inappropriate shocks due to P‐ or T‐wave oversensing (TWOS) ( n = 2), or a rapidly conducted atrial arrhythmia ( n = 1). Three patients, all with hypertrophic cardiomyopathy, received transvenous device upgrades: one to CRT‐P for disease progression, one to TV‐ICD for ATP‐terminable ventricular tachycardia and one to TV‐ICD due to inappropriate shocks from TWOS. Thirteen patients underwent HTx at median 257 days [IQR = 130–453] post S‐ICD; three of whom were bridged with HeartMate 3 LVADs. One LVAD patient needed S‐ICD deactivation due to electromagnetic interference. There were no retained device components following HTx and S‐ICD extraction. Conclusion: In selected pre‐HTx patients, S‐ICDs offer arrhythmic protection while avoiding retained leads post‐HTx.

Background: The risk of rehospitalization in patients with heart failure (HF) has initiated various efforts to prevent and simultaneously improve quality of life. Self-monitoring at home is one option, and technology is increasingly being used for this purpose. Objective: This pilot study aimed to evaluate the feasibility and preliminary effects of a digital home monitoring intervention on patient-reported outcomes and 30-day readmissions among patients with HF in Indonesia. Methods: A mixed methods pilot study was conducted, combining qualitative system development and quantitative evaluation. Patients were assigned to an intervention group (digital monitoring) or control group (standard care). Readmission rates were compared using chi-square tests and odds ratios. Changes in Kansas City Cardiomyopathy Questionnaire scores were analyzed using linear mixed-effects models. Results: A total of 60 patients were included (n=30, 50% in the intervention group; n=30, 50% in the control group). Readmission occurred in 20% (6/30) of patients in the intervention group and 43.3% (13/30) of patients in the control group (odds ratio 0.33, 95% CI 0.10‐1.09; P =.10). Linear mixed-effects analysis showed greater improvement in Kansas City Cardiomyopathy Questionnaire overall summary score in the intervention group ( P =.02). Improvements were observed in the physical limitation, symptom frequency, symptom burden, quality of life, and social limitation domains. During follow-up, 3.3% (1/30) of the patients in the intervention group died of non–HF-related causes, and 10% (3/30) of the patients in the control group died due to HF. Conclusions: This pilot study suggests that digital home monitoring is feasible and associated with improvements in patient-reported outcomes, with a potential signal toward reduced readmission. Larger studies are needed to confirm effectiveness.

BACKGROUND The risk of rehospitalization in heart failure (HF) patients has initiated various preventive efforts and to simultaneously improve the quality of life (QoL) of the patients. Self-monitoring at home is one option, and technology is increasingly being used for this purpose. OBJECTIVE To reduce the risk of hospital readmission and maintain the QoL of HF patients through self-monitoring with the assistance of a digital application. METHODS Starting with determining the need for HF services in National Cardiovascular Center Jakarta in 2024, an application called FineHeart was built and tested on HF patients in a quasi-experimental pilot study. After the User Acceptance Test was completed, HF patients were recruited as intervention group and control group participants. Quality of Life was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) before and after the test. The readmission rate and 4 of the KCCQ parameters were analysed between the 2 groups. RESULTS Of the 72 patients who met the inclusion criteria, thirty participated in the intervention group and thirty in the control group who had signed the consent form. In the intervention group, after 30 days, 22 people complied using the FineHeart application prototype (73.3%), six were readmitted (20%), and one died not because of HF (3.3%). In the control group, 10 were readmitted (33.3%), and three died because of HF (10%). There was a significant relationship between adherence to application usage and an increase in Quality-of-Life scores (p<0.029) and Overall Summary Score (p<0.001)), but not in Self-efficacy and Social Limitation Scores. CONCLUSIONS The findings of this study provide a potential benefit for HF patients to perform self-monitoring at home in collaboration with the hospital team by using FineHeart app. Patient adherence may reduce the risk of readmission and improve QoL. Multicenter studies on larger groups of patients are needed to confirm these preliminary results.