Open AccessHemodynamic‐guided heart‐failure management using a wireless implantable sensor: Infrastructure, methods, and results in a community heart failure disease‐management program
Author(s) -
Jermyn Rita,
Alam Amit,
Kvasic Jessica,
Saeed Omar,
Jorde Ulrich
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22643
Subject(s) - medicine , heart failure , ejection fraction , hemodynamics , confidence interval , cardiology , prospective cohort study , canadian cardiovascular society , pulmonary artery , heart rate , blood pressure , myocardial infarction , angina
Background The real‐world impact of remote pulmonary artery pressure ( PAP ) monitoring on New York Heart Association ( NYHA ) class improvement and heart failure ( HF ) hospitalization rate is presented here from a single center. Hypothesis Methods Seventy‐seven previously hospitalized outpatients with NYHA class III HF were offered PAP monitoring via device implantation in a multidisciplinary HF ‐management program. Prospective effectiveness analyses compared outcomes in 34 hemodynamically monitored patients to a group of similar patients (n = 32) who did not undergo device implantation but received usual care. NYHA class and 6‐minute walk testing were assessed at baseline and 90 days. All hospitalizations were collected after 6 months of the implantation date (average follow‐up, 15 months) and compared with the number of hospitalizations experienced prior to hemodynamic monitoring. Results Patients in both groups had similar distributions of age, sex, and ejection fraction. After 90 days, 61.8% of the monitored patients had NYHA class improvement of ≥1, compared with 12.5% in the controls ( P < 0.001). Distance walked in 6 minutes increased by 54.5 meters in the monitored group (253.0 ± 25.6 meters to 307.4 ± 26.3 meters; P < 0.005), whereas no change was seen in the usual‐care group. After implantation, 19.4% of the monitored group had ≥1 HF hospitalization, compared with 100% who had been hospitalized in the year prior to implantation. The monitored group had a significantly lower HF hospitalization rate (0.16; 95% confidence interval: 0.06‐0.35 hospitalizations/patient‐year) compared with the year prior (1.0 hospitalizations/patient‐year; P < 0.001). Conclusions Hemodynamic‐guided HF management leads to significant improvements in NYHA class and HF hospitalization rate in a real‐world setting compared with usual care delivered in a comprehensive disease‐management program.