Pulmonary Artery Pressure-Guided Heart Failure Management
Which interventions are linked to decreases in heart failure (HF) hospitalizations during ambulatory pulmonary artery (PA) pressure-guided management?
The study authors analyzed medical therapy data from the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in Class III Heart Failure) trial to determine what interventions reduced hospitalizations in the actively monitored group. The study cohort was comprised of 550 New York Heart Association (NYHA) class III patients with HF hospitalization randomized to the active monitoring group (PA pressure-guided HF management plus standard of care) or to the blind therapy group (HF management by standard clinical assessment). All patients were followed for a minimum of 6 months. They summarized data as frequencies and percentages for categorical variables. Continuous variables are presented as mean ± standard deviation. For all statistical analysis, significance levels were two-sided with a p value < 0.05.
Both groups had similar baseline medical therapy. The study authors found that after 6 months, the active monitoring group experienced a higher frequency of medication adjustments (2,468 vs. 1,061 changes in the blind therapy group; p < 0.0001), and significant increases in the doses of diuretics (1,547 vs. 585; p < 0.0001), vasodilators, and neurohormonal antagonists (p < 0.05 for each drug class). Across the range of baseline PA diastolic pressures, the estimated frequency of diuretic changes made by investigators in the active monitoring group was 2.8 times greater intensification of diuretics in patients in the actively monitored group than in the blind therapy group (incidence rate ratio [IRR], 2.78; 95% confidence interval, 2.53-3.06; p < 0.0001). Across the range of baseline PA diastolic pressures, the frequency of vasodilator changes in the active monitoring group was 3.0 times greater than in the blind therapy group (IRR, 2.97; 95% confidence interval, 2.39-3.73; p < 0.0001). Baseline estimated glomerular filtration rate was similar in both groups. After 6 months of follow-up, there were no significant changes in serum creatinine or estimated glomerular filtration rate between the two groups.
The study authors concluded that incorporation of a PA pressure-guided treatment algorithm to decrease filling pressures led to targeted changes, particularly in diuretics and vasodilators, and was more effective in reducing HF hospitalizations than management of patient clinical signs or symptoms alone.
This is an important study because it demonstrates interventions that are effective in reducing HF hospitalizations during ambulatory PA pressure monitoring in the motivated patient. Hopefully there will be a study that will show such interventions also reduce mortality.
Keywords: Blood Pressure, Cardiac Surgical Procedures, Creatinine, Diuretics, Glomerular Filtration Rate, Heart Failure, Hospitalization, Pulmonary Artery, Standard of Care, Vasodilator Agents
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