Studies examining the management of stable patients with an Impella 5.5 on stepdown care, application of innovative technologies to stratify risk and manage heart failure (HF), and more are being presented at Technology and Heart Failure Therapeutics (THT) 2025 in Boston, MA, and were simultaneously published Feb. 11 in JACC Journals.

Management of clinically stable patients implanted with Impella 5.5 on a stepdown unit was found to be both feasible and associated with low rates of device-related adverse events, according to a single-center study published in JACC: Heart Failure.

Anthony Carnicelli, MD, FACC, et al., included 91 patients (median age 59, 23.3% female, 60% Black) with an Impella 5.5 managed by the facility between Jan. 1, 2023, and Aug. 31, 2024, with 60 (65.9%) managed on a stepdown unit.

Overall, 27 adverse events were reported in 23 (38.3%) patients while on stepdown, including three (5.0%) patients who experienced more than one adverse event. Most common adverse events were major hemolysis (11 events), bleeding (six events), bacteremia (four events), major vascular injury (three events), stroke/transient ischemic attack (two events) and heparin-induced thrombocytopenia (one event).

The authors additionally note that hospital facility fees were 61% lower ($1,222 per day) for stepdown unit care in comparison to intensive care unit (ICU) care. The culmination of Impella patient-days on stepdown was 1,114 (median 11 [7,23], mean 18.6±18.7, range 1-81 days) over the study period, resulting in a total cost savings of $1,361,308 and median cost savings of $13,442 per patient (range $1,222 to $98,982).

While the authors note several benefits of caring for clinically stable patients with an Impella 5.5 on stepdown care, they also highlight various challenges in implementing such care, including "the need for a designated, geographically-regionalized unit, nursing ratio flexibility and logistical consideration regarding ICU/stepdown rounding teams."

Several innovations in the use of novel technologies to better manage patients with HF were also featured in JACC: Basic to Translational Science.

In a research letter authored by Jonathan Grinstein, MD, FACC, et al., the Virtual Patient Simulator, a clinical decision support tool using patient-specific data from hemodynamic assessment in conjunction with a machine learning model for HF patients to more accurately predict an individual's HF trajectory, is introduced.

Aiming to provide a more comprehensive energetic assessment of the heart leading to enhanced risk stratification and improved clinical decision-making, the tool was validated in a cohort of more than 2,000 patients, achieving an "AUC of 0.81 and a negative predictive value of 92% for identifying the need for [heart replacement therapy] or death."

"When used in the outpatient setting, the [Virtual Patient Simulator] can equip providers with key data to assess the benefits of early medical and device therapies and guide timely referrals to transplant centers, ultimately improving patient outcomes," write the authors.

Another research letter on artificial intelligence (AI)-enabled smartwatch electrocardiogram (ECG) monitoring explores the feasibility of early prediction and prevention of HF rehospitalization. Hak Seung Lee, MD, et al., outline a planned prospective, multicenter trial consisting of 220 adult patients recently discharged after HF hospitalization.

Conducted over a 90-day period following discharge, the study's primary endpoint will identify the reduction in HF rehospitalization rates. Secondary outcomes of interest include time to the first HF-related clinical intervention following AI-triggered alerts, rate of unplanned hospitalizations, and improvements in mortality and quality of life.

"This study integrates AI-ECG with smartwatch-based daily monitoring, offering a noninvasive and cost-effective solution for predicting HF exacerbations," state the authors. "Combining precision diagnostics with real-time alerts, it enables timely clinical interventions, addressing a critical unmet need in HF management by reducing rehospitalization."

Additionally, Suresh Gurunathan, MS, and Rishi Puri, MBBS, FACC, present a battery powered and minimally invasive biatrial pressure monitoring system, called PatHFinder, designed to aid in HF management.

Their research letter highlights several aspects of the device's design, including its ability "to provide on-demand and highly accurate pressure readings while consuming very low power."

"PatHFinder's custom sensor is comparable in accuracy to a gold standard," write the authors. "[Its] novel fixation has a very small footprint and hence can allow future transeptal access while providing sufficient safety and embolization."

Read more science from the meeting simultaneously published in JACC: Basic to Translational Science:

• Design of the First-in-Human Gene Therapy Trial of TLT-101 For Chronic HF (FIGHT-HF)
  Pia Balmaceda, MD, et al.
• First-in-Human Experience With a Biventricular, Pulsatile MCS Platform Technology Avoiding Blood Contact: Translational Insights
  Stephen Wildhirt, MD, et al.
• A Noninvasive System For Remote Monitoring of Left Ventricular Filling Pressures
  Allan Böhm, MD, et al.
• Continuous Molecular Monitoring For Precision HF Care
  Alex M. Yoshikawa, PhD
• A Novel Transaortic Pulsatile Pump to Unload the Left Ventricle
  James Kim, MD, et al.
• Implantable Cardiac Patch Continuously Monitors Acute HF Biomarkers In Vivo and Ex Vivo
  Devleena Das, PhD, et al.
• Reviving Hearts, Restoring Lives: Long-Term Outcomes of Allogeneic iPSC-Cardiomyocytes Transplantation For Advanced HF Patients
  He Zhang, MD, et al.