Wearable Remote Monitoring of Heart Rate and Respiratory Rate for Heart Failure

January 25, 2023 updated by: Milton S. Hershey Medical Center
The primary objective of this study is to study in heart failure (HF) patients to better assess HF disease state, which can aid in management and improve outcomes. Primary aims of the study include: (1) Measure HR and RR at rest and during daily activity using the WHOOP device. (2) Correlate HR and RR response to activity to New York Heart Association (NYHA) class and 90-day HF hospitalization rate. (3) Identify additional predictors of NYHA class and HF hospitalization rate for algorithm development to use the WHOOP device as a clinical tool for HF management.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Heart Failure (HF) is a challenging condition to manage, with hospital readmission for HF exacerbation having negative impacts on patient outcomes and financial burden to both patient and health system [Lloyd-Jones, 2010; Yancy, 2017; Ross, 2009; Chaudhry, 2007]. An intuitive need for more sensitive predictors of HF exacerbations has led researchers to explore remote monitoring as a possible answer. Consumer-owned sensors have become more accurate in their recording of vital signs, and thus could hold potential for remote monitoring [Dickinson, 2018]. The combined measure of heart rate (HR) and respiratory rate (RR) has been shown to predict New York Heart Association (NYHA) HF class, an indicator of severity of heart disease, in implantable cardiac devices with multi-sensor monitoring capabilities [Auricchio, 2014; Prasun, 2019; Boehmer, 2015; Boehmer, 2017]. Heart rate variability (HRV), a measure of sympathetic autonomic function, has also shown potential in prediction of adverse cardiac events [Al-Zaiti, 2019; Shaffer, 2017; Bullinga, 2005; Tsuji, 1996].

The WHOOP device, a wearable strap similar to a Fitbit, allows for real-time HR monitoring and can determine RR using respiratory sinus arrhythmia [www.whoop.com/experience; Berryhill, 2020]. It is one of the few devices on the market that can accurately track heart rate as well as respiratory rate in real-time (during activity) and is equipped with a multidirectional accelerometer for activity tracking. The WHOOP device was recently externally validated against polysomnography and continuous electroencephalogram (EEG) for sleep tracking, and continuous electrocardiogram (ECG) for HR and HRV (with less than 5% error) [Berryhill, 2020]. HRV, which represents the balance of the sympathetic and parasympathetic nervous systems, is a known predictor of cardiac events. It is especially useful in HF, which is a chronically elevated catecholamine state leading to depressed HRV and is tied to NYHA HF class, an indicator of severity of disease [Bullinga, 2005; Tsuji, 1996].

Data so far regarding the efficacy of remote physiologic monitoring using cardiac implantable electronic devices (CIEDs), although promising in theory, has not yet proved sensitive in the detection of HF exacerbation. The aim of the CLEPSYDRA study was to use data extracted from implanted cardiac resynchronization therapy with defibrillation (CRT-D) devices in HF patients to predict heart failure events; although the main variables used in the novel algorithm, minute ventilation and patient activity, would intuitively seem to be predictors of poor outcome/HF exacerbation, the sensitivity of the algorithm to predict an event was only 34% [6]. It would appear that this combination of variables is not sufficient to predict adverse HF events. However, the HOME-CARE (HOME Monitoring in CArdiac REsynchronization Therapy) study showed more promising results, as their enhanced predictor, utilizing seven diagnostic variables from implanted CRT-Ds, boasted a sensitivity of 65.4% [Sack, 2011]. While the data from these studies is helpful, no study has been able to adequately identify and assess accurate predictors of HF class.

Current efficacious management strategies are limited to hemodynamic or multisensor monitoring systems. However, these are only available in implanted cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. These are not implanted in every HF patient [Al-Zaiti, 2019]. Non-invasive monitoring that provides similar data, such as wearable device monitoring, would expand the cohort of patients that would benefit from remote monitoring and would avoid the risks of having implanted hardware. Furthermore, better prediction of HF severity could help guide follow-up care and predict HF events [Boehmer, 2015; Boehmer 2017]. This would lead to more efficient management, less hospital readmission, and improve outcomes for HF patients overall [Dickinson, 2018].

The investigators propose a feasibility study in HF patients to better assess HF disease state, which can aid in management and improve outcomes. Subjects will wear the WHOOP device, which measures both activity and HR parameters and can derive RR using respiratory sinus arrhythmia, for 90 days. During this period, their HR and RR will be recorded at rest, during activity and post-activity recovery phases. This combined measure of HR/RR has been shown to predict NYHA HF class, an indicator of severity of disease, in implantable devices with multi-sensor monitoring capabilities; thus, it represents a useful management strategy in HF patients [Bullinga, 2005; Tsuji, 1996]. A continuous external monitoring device worn on the wrist, such as the WHOOP device, would provide valuable physiologic data for a cohort of HF patients who were previously unable to be monitored in this fashion. Secondary analysis of this study will investigate the use of intra- and post-activity HR and RR as predictors of hospitalization rates, a common problem in HF patients that correlate with worse mortality outcomes.

Study Type

Observational

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • United States
    • Pennsylvania
      • Hershey, Pennsylvania, United States, 17033
        • Penn State Hershey Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 99 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients, 18 and older, admitted to the hospital with a primary diagnosis of acute heart failure or any stable patient who presents for routine outpatient care, but has a diagnosis of Heart Failure, and is NYHA class II-IV at time of enrollment.

Description

Inclusion Criteria:

  1. Subject has provided informed consent
  2. Male or female over the age of 18 years
  3. The patient is either hospitalized with a primary diagnosis of acute heart failure or was discharged with a primary diagnosis of acute heart failure within 2 weeks prior to enrollment; or carries a diagnosis of heart failure and is seen as an outpatient at Hershey Medical Center.
  4. NYHA functional class II-IV at time of enrollment
  5. Subject willing to wear the WHOOP for the 90-day study period.
  6. Subject owns a phone for pairing with the WHOOP device (required for data storage and transfer)

Exclusion Criteria:

  1. Subjects who are limited by angina.
  2. Subjects with severe aortic stenosis.
  3. Subjects who are hemodynamically unstable requiring support with intravenous vasoactive medications or mechanical circulatory support
  4. Subjects with symptomatic ventricular arrhythmias within the past 6 months.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Hospitalized Heart Failure subjects
Subjects hospitalized for heart failure exacerbation will be enrolled, prior to discharge from hospital, to wear the WHOOP device for 90 days.
Device: WHOOP strap 3.0
WHOOP strap 3.0, a photodiode-based device that tracks heart rate, respiratory rate, sleep, and heart rate variability.
Non-hospitalized Heart Failure subjects
Subjects who have not been hospitalized in the past 1 year, but have a diagnosis of heart failure, will be enrolled during routine outpatient care to wear the WHOOP device for 90 days.
Device: WHOOP strap 3.0
WHOOP strap 3.0, a photodiode-based device that tracks heart rate, respiratory rate, sleep, and heart rate variability.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Daily average heart rate (HR)
Time Frame: 90 days
Daily average heart rate (HR) measured by the WHOOP device. This will be continuously measured for 90 days.
90 days
Daily average respiratory rate (RR)
Time Frame: 90 days
Daily average respiratory rate (RR) measured by the WHOOP device. This will be continuously measured for 90 days
90 days
Heart Failure (HF) hospitalizations
Time Frame: 90 days
Hospital admission for the primary diagnosis for acute, or acute on chronic heart failure) will be assessed via Electronic Medical Record (EMR) and a 90-day patient follow up visit.
90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Average HR isolated during any activity
Time Frame: 90 days
Average HR isolated during any activity lasting greater than 15 minutes (causing at least a 20% increase in heart rate over baseline), for the duration of the activity, measured by the WHOOP device. This will be recorded according to HR gating measures (20% over baseline HR) for the entire 90-day follow up period.
90 days
Max HR isolated during any activity
Time Frame: 90 days
Max HR isolated during any activity lasting greater than 15 minutes (causing at least a 20% increase in heart rate over baseline), for the duration of the activity, measured by the WHOOP device. This will be recorded according to HR gating measures (20% over baseline HR) for the entire 90-day follow up period.
90 days
Average RR isolated during any activity
Time Frame: 90 days
Average RR isolated during any activity lasting greater than 15 minutes (causing at least a 20% increase in heart rate over baseline), for the duration of the activity, measured by the WHOOP device. This will be recorded according to HR gating measures (20% over baseline HR) for the entire 90-day follow up period.
90 days
Max RR isolated during any activity
Time Frame: 90 days
Max RR isolated during any activity lasting greater than 15 minutes (causing at least a 20% increase in heart rate over baseline), for the duration of the activity, measured by the WHOOP device. This will be recorded according to HR gating measures (20% over baseline HR) for the entire 90-day follow up period.
90 days
New York Heart Association (NYHA) functional HF class
Time Frame: 90 days
New York Heart Association (NYHA) functional HF class will be measured at baseline and, if applicable, will be assessed during readmission for heart failure. NYHA Functional Classification places patients in one of four categories based on how much they are limited during physical activity; Class I being best and Class IV being the worst functional class. Class I has no limitation to physical activity, Class II has slight limitation to physical activity, Class III has marked limitation of physical activity, and Class IV is unable to carry out any physical activity without severe discomfort. This will also be repeated at 90-day follow up. Higher NYHA class is expected to be associated with increases in average HR and RR and HR and RR increases with activity, and increased HF hospitalization rate.
90 days
6-minute walk test
Time Frame: 90 days
6-minute walk test is used to assess exercise tolerance and hypoxia with ambulation. Decreased exercise tolerance and increased hypoxia with walking are expected to be associated with worse NYHA HF class, increases in average HR and RR and HR and RR increases with activity, and increased HF hospitalization rate.
90 days
NT-proBNP (N-terminal-pro hormone B-type natriuretic peptide)
Time Frame: 90 days
NT-proBNP is used to assess atrial stretch, a surrogate for acute, chronic, or acute on chronic HF. Increased NT-proBNP (compared to baseline) is expected to correlate with worse NYHA HF class, increases in average HR and RR and HR and RR increases with activity, and increased HF hospitalization rate.
90 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Milton S. Hershey Medical Center

Investigators

  • Principal Investigator: John Boehmer, MD, Milton S. Hershey Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2021

Primary Completion (Actual)

April 14, 2022

Study Completion (Actual)

April 14, 2022

Study Registration Dates

First Submitted

June 29, 2020

First Submitted That Met QC Criteria

June 29, 2020

First Posted (Actual)

July 2, 2020

Study Record Updates

Last Update Posted (Estimate)

January 26, 2023

Last Update Submitted That Met QC Criteria

January 25, 2023

Last Verified

January 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • STUDY15557

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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