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510(k) Data Aggregation

    K Number
    K230842
    Device Name
    SignalHF (IM008)
    Manufacturer
    Date Cleared
    2023-10-25

    (211 days)

    Product Code
    Regulation Number
    870.2210
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    SignalHF (IM008)

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The SignalHF System is intended for use by qualified healthcare professionals (HCP) managing patients over 18 years old who are receiving physiological monitoring for Heart Failure surveillance and implanted with a compatible Cardiac Implantable Electronic Devices (CIED) (i.e., compatible pacemakers, ICDs, and CRTs).

    The SignalHF System provides additive information to use in conjunction with standard clinical evaluation.

    The SignalHF HF Score is intended to calculate the risk of HF for a patient in the next 30 days.

    This System is intended for adjunctive use with other physiological vital signs and patient symptoms and is not intended to independently direct therapy.

    Device Description

    SignalHF is a software as medical device (SaMD) that uses a proprietary and validated algorithm, the SignalHF HF Score, to calculate the risk of a future worsening condition related to Heart Failure (HF). The algorithm computes this HF score using data obtained from (i) a diverse set of physiologic measures generated in the patient's remotely accessible pre-existing cardiac implant (activity, atrial burden, heart rate variability, heart rate, heart rate at rest, thoracic impedance (for fluid retention), and premature ventricular contractions per hour), and (ii) his/her available Personal Health Records (demographics). SignalHF provides information regarding the patient's health status (like a patient's stable HF condition) and also provides alerts based on the SignalHF HF evaluation. Based on an alert and a recovery threshold on the SignalHF score established during the learning phase of the algorithm and fixed for all patients, our monitoring system is expected to raise an alert 30 days (on median) before a predicted HF hospitalization event.

    SignalHF does not provide a real-time alert. Rather, it is designed to detect chronic worsening of HF status. SignalHF is designed to provide a score linked to the probability of a future decompensated heart failure event specific to each patient. Using this adjunctive information, healthcare professionals can make adjustments for the patient based on their clinical judgement and expertise.

    The score and score-based alerts provided through SignalHF can be displayed on any compatible HF monitoring platform, including the Implicity platform. The healthcare professional (HCP) can utilize the SignalHF HF score as adjunct information when monitoring CIED patients with remote monitoring capabilities.

    The HCP's decision is not based solely on the device data which serves as adjunct information, but rather on the full clinical and medical picture and record of the patient.

    AI/ML Overview

    Here's a summary of the acceptance criteria and the study proving the device meets them, based on the provided FDA 510(k) summary for SignalHF:

    Acceptance Criteria and Device Performance for SignalHF

    The SignalHF device was evaluated through the FORESEE-HF Study, a non-interventional clinical retrospective study.

    1. Table of Acceptance Criteria and Reported Device Performance

    For ICD/CRT-D Devices:

    EndpointsAcceptance Criteria (Objective)SignalHF Performance (ICD/CRT-D Devices)
    Sensitivity for detecting HF hospitalization (%)> 40%59.8% [54.0%; 65.4%]
    Unexplained Alert Rate PPY15 days35.0 [27.0; 52.0]

    For Pacemaker/CRT-P Devices:

    EndpointsAcceptance Criteria (Objective)SignalHF Performance (Pacemaker/CRT-P Devices)
    Sensitivity for detecting HF hospitalization (%)> 30%45.9% [38.1%; 53.8%]
    Unexplained Alert Rate PPY15 days37 [24.5; 53.0]

    2. Sample Size and Data Provenance for the Test Set

    • Test Set (Clinical Cohort) Sample Size: 6,740 patients (comprising PM 7,360, ICD 5,642, CRT-D 4,116 and CRT-P 856 - Note: there appears to be a discrepancy in the total sum provided, however, "6,740" is explicitly stated as the 'Clinical cohort' which is the test set).
    • Data Provenance: Retrospective study using data from the French national health database "SNDS" (SYSTÈME NATIONAL DES DONNÉES DE SANTÉ) and Implicity proprietary databases. The follow-up period was 2017-2021.

    3. Number of Experts and Qualifications for Ground Truth

    The document does not explicitly state the number of experts used to establish ground truth or their specific qualifications (e.g., radiologist with 10 years of experience). However, the ground truth was "hospitalizations with HF as primary diagnosis" as recorded in the national health database, implying that these diagnoses were made by qualified healthcare professionals as part of routine clinical care documented within the SNDS.

    4. Adjudication Method for the Test Set

    The document does not specify an adjudication method like 2+1 or 3+1 for establishing the ground truth diagnoses. The study relies on “hospitalizations with HF as primary diagnosis” from the national health database, suggesting that these are established clinical diagnoses within the healthcare system.

    5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

    There is no indication that a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was done to evaluate human reader improvement with AI assistance. The study focuses solely on the standalone performance of the SignalHF algorithm.

    6. Standalone Performance

    Yes, a standalone (algorithm only without human-in-the-loop performance) study was done. The FORESEE-HF study evaluated the SignalHF algorithm's performance in predicting heart failure hospitalizations based on CIED data and personal health records.

    7. Type of Ground Truth Used

    The ground truth used was outcomes data, specifically "hospitalizations with HF as primary diagnosis" recorded in the French national health database (SNDS).

    8. Sample Size for the Training Set

    • Training Cohort Sample Size: 7,556 patients

    9. How the Ground Truth for the Training Set Was Established

    The document states that the algorithm computes the HF score using physiological measures from compatible CIEDs and available Personal Health Records (demographics). It also mentions that the "recovery threshold on the SignalHF score established during the learning phase of the algorithm and fixed for all patients". This implies that the ground truth for the training set, similar to the test set, was derived from the same data sources: "hospitalizations with HF as primary diagnosis" documented within the SNDS database. The training process would have used these documented HF hospitalizations as the target outcome for the algorithm to learn from.

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