Algorithm Using LINQ Sensors for Evaluation And Treatment of Heart Failure

Inclusion Criteria:

• Patient has NYHA Class II or III heart failure per most recent assessment,irrespective of left ventricular ejection fraction (LVEF)

• Patient has documented recent history of symptomatic heart failure, defined asmeeting any one of the following three criteria: 1. Hospital admission with primarydiagnosis of HF within the last 12 months, OR 2. Intravenous HF therapy (e.g. IVdiuretics/vasodilators) or ultrafiltration within the last 6 months, OR 3. Patienthad the following BNP/NT-proBNP within the last 3 months: If LVEF ≥ 50%, then BNP> 150 pg/ml or NT-proBNP > 450 pg/ml OR If LVEF is <50%, then BNP> 300 pg/ml orNT-proBNP > 900 pg/ml

• Patient is willing and able to comply with the protocol, including LINQ ICMinsertion, CareLink transmissions (including adequate connectivity), study visitsand remote care directions.

• Patient is 18 years of age or older.

• Patient has a life expectancy of 12 months or more.

Exclusion Criteria:

• Patient is currently implanted with a cardiovascular implantable electronic device (CIED) (e.g. ICM, pacemaker, ICD, CRT-D or CRT-P device) or hemodynamic monitor.

• Patient is receiving temporary or permanent mechanical circulatory support.

• Patient had MI or PCI/CABG within past 90 days.

• Patient has had a heart transplant, or is currently on heart transplant list.

• Patient has severe valve stenosis on echocardiogram.

• Patient has primary pulmonary hypertension (pre-capillary, WHO group 1,3,4,5).

• Patient is on chronic intravenous inotropic drug therapy (e.g. dobutamine,milrinone).

• Patient has severe renal impairment (eGFR <30 mL/min).

• Patient has systolic blood pressure of < 90 mmHg at the time of enrollment.

• Patient is on chronic renal dialysis.

• Patient is unable to undergo one round of PRN medication intervention (i.e. 4 daysof increased diuretics dose).

• Patient has liver disease, defined as AST/ALT >5x normal, or bilirubin >2x normal.

• Patient has serum albumin < 3 g/dL.

• Patient has hypertrophic obstructive cardiomyopathy, constrictive pericarditis oramyloidosis.

• Patient has complex adult congenital heart disease.

• Patient has active cancer involving chemotherapy and/or radiation therapy.

• Patient weighs more than 500 pounds.

• Patient is pregnant or breastfeeding (all females of child-bearing potential musthave a negative pregnancy test within 1 week of enrollment).

• Patient is enrolled in another interventional study.