Reduction in 90 Day Readmission Rates with Ambulatory Pulmonary Artery Pressure Monitoring

Abstract

<h3>Purpose</h3> In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lowered in patients with ambulatory pulmonary artery pressure (PAP) monitoring guidance. All cause 30 day readmission rates were also lowered in subsequent analysis of this trial. In the era of bundle payments and value-based medicine, the effect of ambulatory hemodynamic monitoring on 90 day all cause readmission rates post HFH has not been explored. <h3>Methods</h3> We conducted a retrospective analysis across the Advocate-Aurora healthcare hospital network using patients undergoing PAP sensor implantation between October 1, 2015, and October 31, 2019. Heart transplant or ventricular assist device (VAD) prior to implant were excluded. Rates of total HFH, 30 day all cause readmission, and 90 day all cause readmission rates after an index HFH event were collected during 12 months before implantation and until heart transplant, VAD, death, or 12 months post implantation. <h3>Results</h3> Among 459 patients, there were 404 total HFHs (0.43 events / per patient / per 180 days) before, compared with 179 HFHs (0.18 events / per patient / per 180 days) after implantation (incidence rate ratio [IRR]: 0.48 (0.40 - 0.57), p < .0001). Compared to pre-implantation, there was a lower rate of 30 day all cause readmission rates (IRR: 0.55 (0.39 - 0.77), p = 0.0006) and 90 day all cause readmission rates post implantation (IRR: 0.45 (0.35 - 0.58), p < .0001). The effect of PAP sensor implant on 90 day all cause readmission incidence rates was consistent across multiple subgroups. (Figure 1) <h3>Conclusion</h3> In a contemporary practice setting across a large hospital network, ambulatory hemodynamic monitoring was associated with lower HFH rates, 30 day and 90 day all cause readmission rates. These benefits support the utility of ambulatory pulmonary pressure monitoring to improve HF management in the era of value based medicine.