Abstract 16893: The Effect of a Nurse-Driven Program Utilizing Implantable Pulmonary Artery Pressure Monitoring to Reduce Hospitalizations in Low-Socioeconomic Urban Patients With Heart Failure

Abstract

Background: The hospitalization rate in patients with heart failure (HF) remains high despite advances in HF treatment. This is especially true in low-socioeconomic urban patients. While implantable pulmonary artery pressure monitors (such as the Abbott CardioMEMS) have been shown to reduce readmissions in highly-selected, overwhelmingly white and male cohorts, their efficacy in low-socioeconomic, urban, minority populations is not known. We hypothesized that a nurse-driven program utilizing the CardioMEMS device in addition to guideline-directed medical therapy could reduce hospitalizations in such patients with heart failure. Methods: At the University of Chicago Medical Center, 18 high-utilizing patients (84% non-white, 44% female) with NYHA Class III HF were implanted with a CardioMEMS following a hospital admission for HF. Data obtained from the CardioMEMS guided a specially-trained nurse in adjusting medications in order to relieve or prevent congestion. Enrolled patients were matched using 30 clinical and demographic variables with contemporaneous control patients with HF who received usual care. All patients had been followed at our center for at least 6 months and continued to receive well-established HF management including education, discharge phone calls, close clinic follow up, and use of evidence-based HF medications throughout the study period. Each patient’s hospitalizations were recorded and compared using Fisher’s exact test. Results: Among the 18 patients who received a CardioMEMS, there were 33 HF-related hospital admissions during the 6 months prior to CardioMEMS implantation. In comparison, there were 5 HF-related hospital admissions in the 6 months post-implantation, representing an 85% decrease in HF-related hospital readmission (p<0.01). Additionally, 14 out of the 18 patients did not have any HF-related hospital admissions after device implant. Similarly, there were 35 all-cause admissions in the 6 months prior to implantation and only 18 admissions in the 6 months after implantation, a decrease of 49% (p<0.01). Control patients had no significant change in HF-related or all-cause hospitalization. Conclusion: A nurse-driven CardioMEMS program significantly reduces HF-related and all-cause hospitalization rates among high-risk, low-socioeconomic, urban patients. Such a program can be used as an effective adjunct to other multidisciplinary interventions in this highly-vulnerable patient population.