Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure: a meta-analysis of three randomized controlled trials

Abstract

Background and Aims Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question. Methods A systematic literature search was performed for randomized clinical trials (RCTs) with PA pressure monitoring devices in patients with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Results Three eligible RCTs were identified that included 1898 outpatients in New York Heart Association functional class II-IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. Mean follow-up was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58-0.86) (p=0.0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61-0.91; p=0.0037) and for all-cause mortality 0.92 (0.73-1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect. Conclusions The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations.

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy

“…25 Across all 3 trials, there was also a higher number of cumulative medication changes in the pulmonary artery pressure monitoring group, especially for diuretics. 25 Pulmonary artery pressure monitoring is an invasive procedure, which may limit acceptability and scalability. However, remote monitoring and clear objective markers of clinical improvement or deterioration may trigger interactions between clinicians and patients to optimize medical therapy.…”

“…25 A meta-analysis of 3 randomized clinical trials (MONITOR-HF, CHAM-PION, and GUIDE-HF) demonstrated that among patients with remote pulmonary artery pressure monitoring, total HF hospitalizations were reduced by 30%, independent of EF. 25 Across all 3 trials, there was also a higher number of cumulative medication changes in the pulmonary artery pressure monitoring group, especially for diuretics. 25 Pulmonary artery pressure monitoring is an invasive procedure, which may limit acceptability and scalability.…”

“…However, remote monitoring and clear objective markers of clinical improvement or deterioration may trigger interactions between clinicians and patients to optimize medical therapy. 25 Furthermore, the clinicians, patients, and caregiver all identified patients' limited knowledge of the disease and medication optimization process as a barrier to GDMT optimization, indicating there is an opportunity to develop more engaging educational materials for both patients and caregivers. The patients included in the HCD sessions were not very familiar with the medication uptitration process and could not clearly identify whether their clinician had worked with them to increase their medication doses.…”

“…Therefore, finding ways to display to patients the quality of their medical therapies compared with best practice recommendations or visual displays that help patients track objective and subjective markers of clinical improvement may be of value. In the future, remote pulmonary artery pressure monitoring could be explored as a way of providing additional objective targets for clinicians and patients 25 . A meta-analysis of 3 randomized clinical trials (MONITOR-HF, CHAMPION, and GUIDE-HF) demonstrated that among patients with remote pulmonary artery pressure monitoring, total HF hospitalizations were reduced by 30%, independent of EF 25 .…”

Haemodynamic monitoring as an opportunity for tailoring diuretics and guideline‐directed medical therapy in heart failure

“…A meta‐analysis of the three CardioMems trials—CHAMPION, GUIDE‐HF, and MONITOR‐HF—reported the use of CardioMEMS to result in a significant reduction in HF hospitalisations, with a hazard ratio of 0.70 (95% confidence interval 0.58–0.86) 4 . This pooled effect shows the potential for CardioMEMS across multiple countries with significantly different healthcare systems and against evolving background therapy.…”