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Hemodynamic Monitoring Benefit Affirmed for Seniors With HF

Ambulatory hemodynamic monitoring is associated not only with lower rates of hospitalization in chronic heart failure (HF) but also better survival, a Medicare study found.

Patients with a wireless pulmonary artery pressure (PAP) sensor had a relative 24% lower rate of such admissions at 12 months post-implant than matched controls (0.65 vs 0.88 per year, P<0.001).

The proportion of days lost due to death or HF hospitalization was similarly lower in the monitored group (HR 0.73, P<0.001), reported Jacob Abraham, MD, of the Providence Heart Institute in Portland, Oregon, and colleagues in JAMA Cardiology.

Those findings were in line with the CHAMPION trial using the implantable CardioMEMS PAP sensor and subsequent studies in the clinical setting, noted Abraham.

What's new, he said, is the mortality data "suggesting that use of CardioMEMS could improve survival."

The death rate was a relative 30% lower with PAP monitoring in the Medicare cohort (0.23 vs 0.30 per year, P<0.001).

"Although we used propensity matching to produce a control arm that is very closely matched to the treatment arm, only a randomized controlled trial can prove these findings definitely. Such a trial, GUIDE-HF, is currently underway," Abraham told MedPage Today.

The GUIDE-HF trial has all-cause mortality as a secondary endpoint in the randomized comparison between patients with CardioMEMS and those with it implanted but not receiving care based on information from it.

Herman-Simon Kado, MD, of Beaumont Hospital in Royal Oak, Michigan, agreed that this investigation reinforces the findings from the CHAMPION trial, while also adding information concerning longer-term outcomes. "This invasive therapy has proven to be superior to the old fashion method that we used to treat heart failure, and we are just getting more evidence that this is hopefully going to be the new standard of care in the future in all patients with heart failure," Kado told MedPage Today.

Kado pointed to the healthcare dollars saved by preventing readmissions, while also improving patient quality of life and long-term outcomes. "So it's a win-win for patients. It's a win-win for doctors. It's a win-win for hospital systems, insurance companies. Everybody across the board is finding a better way to treat heart failure with this new therapy."

Abraham's group evaluated all 1,087 patients with an implantable PAP sensor from the full Medicare claims database and 1,087 controls matched for history of HF hospitalization, number of all-cause hospitalizations, and demographic features.

Propensity scoring based on comorbidities like hypertension, pulmonary disease, diabetes, renal disease, and arrhythmias were taken into account for further matching. Both cohorts had a mean age around 72 years and were 35.1% female.

The researchers acknowledged the inherent limitations of the claims-based, observational design. Key clinical data like natriuretic peptide levels, renal function, and ejection fraction are not known. Complications of sensor implant, indications for PAP sensor implant, and medical therapy were also unavailable.

The study was funded by Abbott.

Abraham disclosed relationships with Abbott and Abiomed.

Kado disclosed no relevant relationships with industry.

Source: https://www.medpagetoday.com/cardiology/chf/79856

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