Pulmonary artery pressure-guided therapy in patients with heart failure using the CardioMEMS device and HF readmissions: analysis of the National Readmissions Database

Abstract

Abstract Background Pulmonary artery pressure (PAP)-guided therapy in patients with heart failure (HF) using the CardioMEMS device (CMM), an implantable PAP sensor, has shown to reduce HF hospitalizations in previous studies. We sought to evaluate the clinical benefit of the CMM device in regard to 30-day, 90-day and 180-day readmission rates in real-world usage. Methods We queried the National Readmission Database (NRD) to identify patients who underwent CMM implantation (ICD 9 & 10 codes) between the years 2014 to 2019 and studied their HF readmissions. We compared CMM patients and their readmissions with a matched cohort of patients with HF without CMM. Multivariable Cox regression analysis was performed to adjust for other predictors of readmissions. Results Prior to matching we identified 5,326,530 weighted HF patients without CMM and 1842 patients with CMM. After propensity score matching for several patients and hospital related characteristics, the cohort consisted of 1839 patients with CMM and 1924 with HF without CMM. Before matching, CMM patients were younger (67.0±13.5 years vs 72.3±14.1 years, P<0.001), more frequently males (62.7% vs 51.5%, P<0.001), with higher rates of prior percutaneous coronary intervention (16.9% vs 13.2%, P=0.002), peripheral vascular disease (29.6% vs 17.8%, P<0.001), pulmonary circulatory disorder (38.7% vs 23.2%, P<0.001), atrial fibrillation (51.2% vs 45.3%, P=0.002), prior left ventricular assist device (1.8% vs 0.2%, P<0.001), high income (32.2% vs 16.4%, P<0.001) and acute kidney disease (43.8% vs 29.9%, P<0.001). Readmission rates at 30-days were 17.3% vs. 20.9% for patients with vs. without CMM respectively and remained statistically significant after matching (17.3% vs. 21.5%, p=0.002). The rates of 90-day (29.1% vs 36.5%, p=0.002) and 180-day (39.6% vs. 46.6%, p=0.009) readmissions were lower in the CMM group. In a multivariable regression model, CMM was associated with lower risk of readmissions (HR, 0.75, 95% CI 0.63–0.89, p=0.001). Conclusion The CMM device was associated with reduced HF rehospitalization rates in a nationally representative cohort of HF patients. Funding Acknowledgement Type of funding sources: None.