Heart Failure Hospitalization Rates Lessened By Hemodynamic Monitoring

Heart failure hospitalization (HFH) rates were found to be lower in patients aided with guidance from an implantable pulmonary artery pressure sensor, when compared to common ambulatory care, according to a recent study.

The study, titled the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients (CHAMPION) trial, studied the effectiveness of HFH reduction from ambulatory hemodynamic monitoring outside of the clinical trial setting.

Led by Dr. Akshay Suvas Desai (pictured), MD, MPH, associate professor at Harvard Medical School and associate director of Brigham Cardiovascular Consultants, researchers reviewed public administrative claims data from the US Centers for Medicare and Medicaid Services (CMS).

The team examined CMS data comparing HF hospitalization rates and associated costs of heart failure care in the periods before and after pulmonary artery pressure (PAP) sensor implantation. Research ran from June 2014 through December 2015.

Researchers compared the HFH rates during pre-defined periods before and after implantation by using a proportional hazards model. At the same time, they accounted for the competing risk of death, ventricular assist device implantation, or cardiac transplantation.

Comprehensive heart failure-related costs were compared over the same periods as well.

Research found that, of the 1,114 patients receiving implants, 1,020 HFHs were reported in the 6 months before — compared to 381 HFHs, 139 deaths, and 17 ventricular assist device implantations or transplants in the 6 months following implantation.

The lower rate of HFH in the post-implantation phase was also associated with a 6-month comprehensive HF cost reduction of $7,433 per patient, according to the study, and was “robust in analyses” restricted to 6-month survivors.

There were similar HFH cost reductions in the subset of 480 patients with complete data available for 12 months before and after implementation.

CMS data suggests reductions in HFHs and cost savings seen in trial populations could be attainable in clinical practice, according to the study. The 45% lowered rate of cumulative HFHs observed at 6 months after implantation versus the 6-month-prior implantation proves preferable to the 28% reduction from PAP-guided therapy over the same time period.

The researchers concluded that ambulatory hemodynamic monitoring for heart failure management would be clinically effective.

However, an accompanying editorial on the study penned by Harlan Krumholz, MD, SM, FACC, and Sanket Dhruva, MD, FACC, noted the research does not have enough evidential strength to research clinical conclusions.

The editorial authors suggest researchers pursue additional independent trials and more detailed studies, noting the paper responds “to the great need for evidence about CardioMEMS,” but is written with casual language in its conclusion.

The study, “Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in "Real-World" Clinical Practice,” was published online on the Journal of the American College of Cardiology.

A press release regarding the research was made available.

Related Coverage:

Bosentan Does Little to Improve Long Term Effects of Heart Failure, Study Says

Heart Failure Associated With Depletion of Core Intestinal Microbiota

Study Determines Exercise Training is Safe for Patients with Heart Failure and Atrial Fibrillation