Nils Hinrichs ^1,2 Alexander Meyer ^1,2,3,4,5* Kerstin Koehler ^2* Thomas Kaas ^2* Meike Hiddemann ^2* Sebastian Spethmann ² Felix Balzer ¹ Carsten Eickhoff ^6* Volkmar Falk ^2,3,5,7* Gerhard Hindricks ^2,5* Nikolaos Dagres ^2* Friedrich Koehler ^2*

• ¹ Charité University Medicine Berlin, Berlin, Germany
• ² Deutsches Herzzentrum der Charité, Berlin, Germany
• ³ Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Baden-Württemberg, Germany
• ⁴ Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
• ⁵ Partner site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Berlin, Germany
• ⁶ University of Tübingen, Tübingen, Baden-Württemberg, Germany
• ⁷ ETH Zürich, Zurich, Zürich, Switzerland

Remote patient management may improve prognosis in heart failure. Daily review of transmitted data for early recognition of patients at risk requires substantial resources that represent a major barrier to wide implementation. An automated analysis of incoming data for detection of risk for imminent events would allow focusing on patients requiring prompt medical intervention.We analysed data of the Telemedical Interventional Management in Heart Failure II (TIM-HF2) randomized trial that were collected during quarterly in-patient visits and daily transmissions from non-invasive monitoring devices. By application of machine learning, we developed and internally validated a risk score for heart failure hospitalisation within seven days following data transmission as estimate of short-term patient risk for adverse heart failure events. Score performance was assessed by the area under the receiver-operating characteristic (ROCAUC) and compared with a conventional algorithm, a heuristic rule set originally applied in the randomized trial.The machine learning model significantly outperformed the conventional algorithm (ROCAUC 0.855 vs. 0.727, p<0.001). On average, the machine learning risk score increased continuously in the three weeks preceding heart failure hospitalisations, indicating potential for early detection of risk. In a simulated one-year scenario, daily review of only the one third of patients with the highest machine learning risk score would have led to detection of 95 % of HF hospitalisations occurring within the following seven days.A machine learning model allowed automated analysis of incoming remote monitoring data and reliable identification of patients at risk of heart failure hospitalisation requiring immediate medical intervention. This approach may significantly reduce the need for manual data review.