{
  "abstract": "Introduction In 2024, NICE recommended TriageHF remote monitoring for patients with heart failure (HF) and cardiac implantable devices. This was to facilitate the early detection of physiological deterioration and enable timely clinical interventions to reduce adverse outcomes. 1 NICE also highlighted the need for further evidence regarding diagnostic accuracy and cardiovascular (CV) endpoints. In 2025, a novel cardiac physiologist led TriageHF pathway was introduced within our Trust.Aims Evaluate the implementation of a physiologist led TriageHF pathwayDetermine the prevalence of adverse CV events following high risk TriageHF alertsAssess the diagnostic performance of TriageHF to predict adverse CV eventsMethods A prospective study of the novel TriageHF pathway was performed June-December 2025. High risk alerts were identified by cardiac physiologists who contacted patients, completed an electronic HF symptom proforma, arranged a 1 month device check and contacted a consultant cardiologist to provide clinical advice ± review. CV outcomes (worsening heart failure, HF hospitalisation, CV death) were recorded and the diagnostic performance of TriageHF alerts assessed.Results Of 450 patients with TriageHF-capable devices, 7% (n=31) generated a high-risk TriageHF alert. All patients were contacted by a cardiac physiologist, 68% had an electronic HF proforma completed and 97% a scheduled 1-month device reassessment. A consultant cardiologist was notified in all cases, and outcome data was available for 94% patients (n=29).Among patients with high-risk alerts, worsening heart failure occurred in 52% of patients, arrhythmias in 28%, other acute illness in 17% and no identifiable cause in 3%. Of those with worsening heart failure, 91% were classified as medium/high risk following our physiologist-led clinical assessment, supporting this process in refining those at risk.There was a high prevalence of adverse cardiac outcomes. Eight patients had a HF hospitalisation (28%), three of whom subsequently died. One patient died at home from a CV cause while receiving palliative care, resulting in a total of four CV deaths (14%). Two patients (7%) required hospital admission prior to their scheduled clinic review, highlighting the importance of rapid action following high risk alerts.A high-risk TriageHF alert predicted HF hospitalisation or CV death with a sensitivity of 90% specificity of 85%, positive predictive value of 31% and negative predictive value of 99%, supporting its role as an effective initial screening tool.Conclusions A novel physiologist led TriageHF pathway was successfully integrated into clinical practice with excellent adherence and potential cost saving implicationsIn patients with high risk TriageHF alerts, there was a high prevalence of adverse CV events indicating a high-risk population and supporting early clinical interventionHigh risk TriageHF alerts predicted HF hospitalisation or CV death with good diagnostic performanceCompleted by the cardiac physiologist for patients who receive a high risk TriageHF alertAbstract 425 Figure 1Clinical assessment scoreAbstract 425 Figure 2Outcomes of patients with worsening heart failure identified following a high risk TriageHF alertReference National Institute for Health and Care Excellence (NICE). Heart failure algorithms for remote monitoring in people with cardiac implantable electronic devices. HTG730. Published October 2024. Available from: https://www.nice.org.uk/guidance/htg730",
  "authors": [
    {
      "affiliations": [
        "Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Clare Bannister"
    },
    {
      "affiliations": [
        "Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Hannah Bartrip"
    },
    {
      "affiliations": [
        "Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Nicole Campbell"
    },
    {
      "affiliations": [
        "Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Alina Hua"
    },
    {
      "affiliations": [
        "Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Jess Webb"
    }
  ],
  "title": "425 A novel cardiac physiologist led TriageHF clinical pathway for patients with heart failure and cardiac implantable devices",
  "uid": "4e8611c2-b7f9-563f-8dc2-2b863d398a7e"
}