Understanding adherence to the CardioMEMS pulmonary artery pressure monitoring system for heart failure: A qualitative study

Haynes, Sarah C.; Pallin, Rocco; Tong, Kathleen; Henderson, Stuart; Romano, Patrick S.

doi:10.1016/j.hrtlng.2020.01.011

Cited by 10 publications

(3 citation statements)

References 36 publications

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“…These differences could be explained by cognitions of patients regarding the efficacy of the intervention and the usability of the intervention [75]. Moreover, low health literacy or simply a lack of knowledge about the syndrome could also contribute to non-adherence [76][77][78]. In clinical practice, one should therefore educate patients about the importance of disease management with medication, invasive therapy, cardiac rehabilitation, and care pathways [65,79].…”

Section: Discussionmentioning

confidence: 99%

Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

et al. 2022

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Heart failure (HF) is a major health concern, which accounts for 1–2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.

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Section: Discussionmentioning

confidence: 99%

Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

et al. 2022

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“…In the CardioMEMS approval trial, 10 after 6 months there was still an average of 1.27 days between transmissions, and >80% of patients sent daily transmissions in the follow‐up study. 11 One smaller study noted that patients’ perceived adherence was less than actual adherence with IHM transmissions, reporting a daily transmission range of 19% to 99%, 20 and another reported more heart failure events with increased number of days between transmissions. 21 In our cohort, only 3 (18%) patients had transmission rates similar to the larger IHM trials, and as noted <50% of HFHs had IHM transmissions within 1 week of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Marshall,

Rajpal,

Mah

et al. 2023

JAHA

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Background Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. Methods and Results This single‐center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device‐related complications in patients with Fontan circulation referred for IHM placement (2015–2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow‐up Model for End‐Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21–48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device‐related procedural complications. In follow‐up (median, 35 [range, 6–83] months), 1 patient developed a pulmonary embolism (possibly device‐related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0–1.0] versus 0.6 [0–2.3]; P =0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End‐Stage Liver Disease Excluding International Normalized Ratio scores ( R 2 =0.588, P <0.001), though catheterization pressures were not ( R 2 =0.140, P =0.139). The long‐term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P =0.041), which was not reproduced with catheterization pressures (log rank P =0.764). Conclusions In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device‐related complications were low. IHM pressures may better represent real‐life conditions compared with catheterization given associations with mortality and Model for End‐Stage Liver Disease Excluding International Normalized Ratio score.

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“…Compared with the CardioMEMS implant [43,44], this subcutaneous implant is less invasive, and once the gateway is installed, data transmission will not require any commitment (a priori) on the part of the patient. It is already known that adherence to self-care is an important issue in the field of chronic conditions [45], including heart failure [46][47][48]. Therefore, it seems interesting to use low-invasive implants to deliver medication [49] or, in our case, to monitor patients living with heart failure.…”

Section: Pros and Cons Of An Implantable Monitoring Devicementioning

confidence: 99%

Patients’ Information Needs Related to a Monitoring Implant for Heart Failure: Co-designed Study Based on Affect Stories

Davat¹,

Martin-Juchat²

2023

JMIR Hum Factors

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Background RealWorld4Clinic is a European consortium that is currently developing an implantable monitoring device for acute heart failure prevention. Objective This study aimed to identify the main issues and information needs related to this new cardiac implant from the patients’ perspective. Methods A total of 3 patient collaborators were recruited to help us design the study. During 4 remotely held meetings (each lasting for 2 hours), we defined the main questions and hypotheses together. Next, 26 additional interviews were conducted remotely to test these hypotheses. During both phases, we used affect stories, which are life narratives focusing on affect and the relationship between patients and the care ecosystem, to highlight the main social issues that should be addressed by the research according to the patients. Results Context of diagnosis, age, and severity of illness strongly influence patient experience. However, these variables do not seem to influence the choice regarding being implanted, which relies mostly on the individual patient’s trust in their physicians. It seems that the major cause of anxiety for the patient is not the implant but the disease itself, although some people may initially be concerned over the idea of becoming a cyborg. Remote monitoring of cardiac implants should draw on existing remote disease management programs focusing on a long-term relationship between the patient and their medical team. Conclusions Co-design with affect stories is a useful method for quickly identifying the main social issues related to information about a new health technology.

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Understanding adherence to the CardioMEMS pulmonary artery pressure monitoring system for heart failure: A qualitative study

Cited by 10 publications

References 36 publications

Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Patients’ Information Needs Related to a Monitoring Implant for Heart Failure: Co-designed Study Based on Affect Stories

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