Integrated Diagnostics Driven Diuretic and Chronic Medication Management for Heart Failure

The study is expected to be conducted at up to 20 centers located in the United States. Up to
400 subjects will be enrolled to yield up to 200 eligible subjects that meet screening
criteria. This study will be conducted in subjects with an implanted, commercially available,
Medtronic, CRT-D device. Each enrolled subject will be followed every 2 months from time of
enrollment to end of the study.The study will end after the last enrolled subject completes
the 12-month follow-up.

Inclusion Criteria:

- Subject (or subject's legally authorized representative) is willing and able to
provide written informed consent

- Subject has been implanted with a CRT device for at least 9 months and has had a
wireless Medtronic CRT-D device for at least 34 days

- Subject has >1 year life expectancy

- Subject's CRT-D device has at least 18 months of device longevity left

- Subject has an eGFR> 25 ml/min/1.73 m2

- Subject is NYHA Class II or III

- Subject is NYHA Class II or III • Subject has elevated BNP values (BNP>400 or NTpro
BNP>800) within the last 3 months OR Subject has had at least one OptiVol threshold
crossing in the last 9 months OR Subject has had a HF event within the last 9 months

HF event is defined as meeting any one of the following two criteria:

1. Subject was admitted to the hospital for worsening HF OR

2. Subject has received Intravenous HF therapy (e.g. IV diuretics/vasodilators) or
ultrafiltration at any settings including:

- Emergency Department

- Ambulance

- Observation Unit

- Urgent Care

- HF/Cardiology Clinic

- Patient's Home

- Subjects who are currently prescribed and taking medications for the
management of heart failure and are able to tolerate transient increases in
diuretic dosage

- Subject is willing and able to comply with the protocol, including
screening, baseline and programming visit(s), remote care directions,
follow-up visits, and exit visit

- Subject can send device transmissions and daily biometric data with in-home
patient devices

Exclusion Criteria

- Subject has systolic BP of < 90 mmHg at the time of enrollment

- Subject not responsive to diuretic therapy or is on chronic renal dialysis

- Subject unable to undergo one round of medication intervention (3 day up-titration of
diuretic) without requiring safety check

- Subjects enrolled in a concurrent study that may confound the results of this study
without documented pre-approval from a Medtronic study manager

- Subject weighs more than 500 pounds

- Subject is younger than 18 years of age

- Subject has hemodynamic monitoring device implanted