Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in “Real-World” Clinical Practice

Desai, Akshay S.; Bhimaraj, Arvind; Bharmi, Rupinder; Jermyn, Rita; Bhatt, Kunjan; Shavelle, David M.; Redfield, Margaret M.; Hull, Robert W.; Pelzel, Jamie; Davis, Kevin J.; Dalal, Nirav; Adamson, Philip B.; Heywood, J. Thomas

doi:10.1016/j.jacc.2017.03.009

Cited by 146 publications

(86 citation statements)

References 22 publications

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“…Daily monitoring of pulmonary pressures in patients with heart failure using a wireless PA pressure monitor—and by acting on elevation of pulmonary pressures with up‐titration of diuretics, RAAS inhibitors or vasodilator drugs—significantly reduced PA pressures and hospitalizations for heart failure, both in trial setting and in real‐world patients . Wireless monitoring of PA pressures currently has a class IIb‐B recommendation in order to reduce the risk of recurrent hospitalizations for heart failure .…”

Section: Treatmentmentioning

confidence: 99%

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Gorter

Veldhuisen

Bauersachs

et al. 2017

European J of Heart Fail

244

223

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There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.

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Section: Treatmentmentioning

confidence: 99%

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Gorter

Veldhuisen

Bauersachs

et al. 2017

European J of Heart Fail

244

223

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“…Specifically, frequent monitoring of PA pressures has been shown to significantly reduce long-term HF hospitalization rates as shown in both the CHAMPION [CardioMEMS™ Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients] clinical trial and in real-world experience. [3][4][5] Despite maximal guideline-directed medical therapies and haemodynamic-guided care, clinical disease progression occurs in HF patients, in many cases requiring left ventricular assist devices (LVADs) or heart transplant. LVADs have been an increasingly utilized therapy for those with advanced HF and have resulted in improvements in patient functional status and quality of life, in addition to improved clinical outcomes relative to medical therapy.…”

Section: Introductionmentioning

confidence: 99%

Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring

et al. 2018

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AimsThe time course of changes in pulmonary artery (PA) pressure due to left ventricular assist devices (LVADs) is not well understood. Here, we describe longitudinal haemodynamic trends during the peri‐LVAD implantation period in patients previously implanted with a remote monitoring PA pressure sensor.Methods and resultsWe retrospectively studied PA pressure trends in patients implanted with CardioMEMS™ PA pressure sensor between October 2007 and March 2017 who subsequently had an LVAD procedure. Data are presented as mean ± standard deviation, and P‐values are calculated using standard t‐test with equal variance. Among 436 patients in cohort, 108 (age 58 ± 11 years, 82% male) received an LVAD and 328 (age 60 ± 13 years, 70% male) did not. The mean PA pressure at sensor implant was higher by 29% (P < 0.001) among patients who later received LVAD. Mean PA pressure 6 months prior to LVAD implant was 35.5 ± 8.5 mmHg, increasing to 39.4 ± 9.9 mmHg (P = 0.04) at 4 weeks before LVAD, and then decreasing 27% to 28.8 ± 8.4 mmHg (P < 0.001) at 3 months post‐implant and stabilizing at 31.0 ± 9.4 mmHg at 1 year.ConclusionsPatients who later receive LVADs have higher PA pressures at sensor implant and show a further increase leading up to LVAD implantation. There is a significant reduction of PA pressures post‐LVAD implantation that persists long term. PA pressure monitoring may aid in the clinical decision making of timing for LVAD implantation and in management of LVAD patients.

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“…Nevertheless, the aforementioned study by Costanzo et al 23 established a link between an algorithm-based medication titration scheme, intracardiac pressure reduction and a decrease in HFH rates. Inpatient implantation of the sensor did not impact these findings 25. These findings support those of the CHAMPION trial but do not replace the need for additional clinical trials.…”

Section: Real-world Clinical Experiencementioning

confidence: 52%

“…Desai et al 25 performed an analysis of Medicare beneficiaries with HF, not included in CHAMPION, comparing HFH rates before and after CardioMEMS sensor implantation with each patient serving as their own historical control. The study included 1114 patients with 6 months of continuous data and 480 patients with 12 months of continuous data.…”

Section: Real-world Clinical Experiencementioning

confidence: 99%

Chronic heart failure management and remote haemodynamic monitoring

Wolfson

Fong

Grazette

et al. 2018

Heart

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Heart failure (HF) has a large societal and economic burden and is expected to increase in magnitude and complexity over the ensuing years. A number of telemonitoring strategies exploring remote monitoring and management of clinical signs and symptoms of congestion in HF have had equivocal results. Early studies of remote haemodynamic monitoring showed promise, but issues with device integrity and implantation-associated adverse events hindered progress. Nonetheless, these early studies established that haemodynamic congestion precedes clinical congestion by several weeks and that remote monitoring of intracardiac pressures may be a viable and practical management strategy. Recently, the safety and efficacy of remote pulmonary artery pressure-guided HF management was established in a prospective, single-blind trial where randomisation to active pressure-guided HF management reduced future HF hospitalisations. Subsequent commercial use studies reinforced the utility of this technology and post hoc analyses suggest that tight haemodynamic management of patients with HF may be an additional pillar of therapy alongside established guideline-directed medical and device therapy. Currently, there is active exploration into utilisation of this technology and management paradigm for the timing of implantation of durable left ventricular assist devices (LVAD) and even optimisation of LVAD therapy. Several ongoing clinical trials will help clarify the extent and utility of this strategy along the spectrum of patient with HF from individuals with chronic, stable HF to those with more advanced disease requiring heart replacement therapy.

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Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in “Real-World” Clinical Practice

Abstract: As in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice is associated with lower HFH and comprehensive HF costs. These benefits are sustained to 1 year and support the "real-world" effectiveness of this approach to HF management.

Cited by 146 publications

References 22 publications

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring

Chronic heart failure management and remote haemodynamic monitoring

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