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Advisor(s)
Abstract(s)
Introdução: O surto da pandemia Coronavírus 2019 (COVID-19) forçou muitos países a impor restrições de circulação (e consequentes períodos de confinamento), como medida preventiva contra a transmissão deste vírus. Os períodos de confinamento proporcionaram uma situação temporária e bem definida das variações no perfil de atividade física dos doentes portadores de dispositivos cardíacos implantáveis (DCIs) que surgem como base de tratamento da insuficiência cardíaca (IC). Através da monitorização remota (MR) disponível nestes dispositivos foi possível investigar o impacto associado a estes períodos e a correlação temporal dos parâmetros fisiológicos nestes doentes de risco acrescido. Métodos: Estudo retrospetivo, sistemático, analítico e longitudinal de amostragem. Envolveu 79 doentes com IC e portadores de DCIs com sistema de MR Carelink™, seguidos em follow-up remoto durante um período médio de 20 meses, num Hospital Central Português inserido no Serviço Nacional de Saúde. Os dados foram recolhidos entre Fevereiro de 2020 a Novembro de 2021, sendo extraídos por meio da conversão proprietária da Medtronic,Inc Portugal, num formato estatisticamente analisável através do software Python, versão 3.8.18. A presente análise explorou o impacto dos confinamentos sobre os parâmetros fisiológicos recolhidos pelo sistema de MR, com o objetivo de determinar o tempo de resposta das alterações dos parâmetros à diminuição da atividade física. Resultados: No período de estudo analisado verificou-se impacto estatisticamente significativo nos valores de atividade física (p<0,0001), na frequência cardíaca (FC) diurna e noturna (p<0,0001), na variabilidade da FC (VFC) (p<0,0001), na impedância intratorácica (IT) acumulativa (p<0,0001) e nas sístoles prematuras ventriculares/dia (p = 0.02). As alterações com correlação máxima ocorreram nos primeiros 10 dias após as quebras na atividade física, com impacto na FC diurna e noturna e na VFC. Mais tardiamente com impacto na IT acumulativa e nas SPV(n/dia). Conclusão: As alterações da FC diurna, noturna e da VFC evidenciaram-se sensíveis à resposta da atividade física nos períodos em estudo.
Introduction: The outbreak of the Coronavirus 2019 (COVID-19) pandemic forced many countries to impose movement restrictions (and consequent periods of confinement), as a preventive measure against the transmission of this virus. Periods of confinement provided a temporary and well-defined situation of variations in the physical activity profile of patients with implantable cardiac devices (ICDs) that appear as a basis for treating heart failure (HF). Through the remote monitoring (MR) available in these devices, it was possible to investigate the impact associated with these periods and the temporal correlation of physiological parameters in these increased risk patients. Methods: Retrospective, systematic, analytical, and longitudinal sampling study. It involved 79 patients with HF and patients with ICDs using the Carelink™ MR system, followed in remote follow-up for an average period of 20 months, in a Portuguese Central Hospital within the National Health Service. Data were collected between February 2020 and November 2021, being extracted through Medtronic, Inc Portugal's proprietary conversion, into a statistically analyzable format using Python software, version 3.8.18. The present analysis explored the impact of confinements on physiological parameters collected by the MR system, with the aim of determining the response time of parameter changes to decreased physical activity. Results: During the study period analyzed, there was a statistically significant impact on physical activity values (p<0.0001), on daytime and nighttime heart rate (HR) (p<0.0001), on HR variability (HRV) (p <0.0001), on cumulative intrathoracic impedance (IT) (p<0.0001) and in premature ventricular systoles/day (p = 0.02). The changes with maximum correlation occurred in the first 10 days after the breaks in physical activity, with an impact on daytime and nighttime HR and HRV. Later, with an impact on cumulative IT and in SPV(n/day). Conclusion: Changes in daytime and nighttime HR and HRV were sensitive to the response to physical activity in the periods under study.
Introduction: The outbreak of the Coronavirus 2019 (COVID-19) pandemic forced many countries to impose movement restrictions (and consequent periods of confinement), as a preventive measure against the transmission of this virus. Periods of confinement provided a temporary and well-defined situation of variations in the physical activity profile of patients with implantable cardiac devices (ICDs) that appear as a basis for treating heart failure (HF). Through the remote monitoring (MR) available in these devices, it was possible to investigate the impact associated with these periods and the temporal correlation of physiological parameters in these increased risk patients. Methods: Retrospective, systematic, analytical, and longitudinal sampling study. It involved 79 patients with HF and patients with ICDs using the Carelink™ MR system, followed in remote follow-up for an average period of 20 months, in a Portuguese Central Hospital within the National Health Service. Data were collected between February 2020 and November 2021, being extracted through Medtronic, Inc Portugal's proprietary conversion, into a statistically analyzable format using Python software, version 3.8.18. The present analysis explored the impact of confinements on physiological parameters collected by the MR system, with the aim of determining the response time of parameter changes to decreased physical activity. Results: During the study period analyzed, there was a statistically significant impact on physical activity values (p<0.0001), on daytime and nighttime heart rate (HR) (p<0.0001), on HR variability (HRV) (p <0.0001), on cumulative intrathoracic impedance (IT) (p<0.0001) and in premature ventricular systoles/day (p = 0.02). The changes with maximum correlation occurred in the first 10 days after the breaks in physical activity, with an impact on daytime and nighttime HR and HRV. Later, with an impact on cumulative IT and in SPV(n/day). Conclusion: Changes in daytime and nighttime HR and HRV were sensitive to the response to physical activity in the periods under study.
Description
Trabalho final de Mestrado para obtenção do grau de Mestre em Engenharia Biomédica
Keywords
COVID-19 Insuficiência cardíaca Dispositivos cardíacos Implantáveis Monitorização remota Parâmetros fisiológicos COVID-19 Heart failure implantable cardiac devices Remote monitoring
Citation
Carvalho, Ana catarina Gonçalves Pinto de - Estudo do impacto da pandemia COVID-19 nos parâmetros de monitorização remota em doentes com Insuficiência Cardíaca portadores de CDI/ TRC. Lisboa: Instituto Superior de Engenharia de Lisboa, 2023. Dissertação de Mestrado