Hemodynamic, Therapeutic, and Clinical Outcomes of Ambulatory Pressure-Guided Heart Failure Management

Abstract

Background
 Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.
 Methods
 We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.
 Results
 Patients had an average change in mean PAP of -3.9±1.3 mmHg at 6 months and -5.7±2.1 mmHg at 12 months. Compared to the pre-implant time period, hospital days for HF-related hospitalizations decreased by 6.9 (95% CI = 3.3-10.5) days per patient at 6 months (p<0.001) and 7.9 (95% CI = 4.3-11.5) days per patient at 12 months (p<0.001). Over 12 months, patients with baseline PAP 25-35mmHg and >35mmHg experienced a drop in PAP while their number of medication adjustments decreased, and patients with baseline PAP <25mmHg experienced a rise in PAP and an increase in medication adjustments
 Conclusions 
 PAP-guided HF management involved time-varying intensity of medication changes, which correlated with sustained reductions in hospital stay.