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Ambulatory Hemodynamic Monitoring in the Real World
Study Questions:
What is the effectiveness of ambulatory hemodynamic monitoring in reducing heart failure hospitalization (HFH) in the "real world"?
Methods:
The authors conducted a retrospective cohort study using U.S. Medicare claims data from patients undergoing pulmonary artery pressure (PAP) sensor implantation between June 1, 2014 and December 31, 2015. Using the Andersen-Gill extension for recurrent events to the Cox proportional hazards model (while accounting for the competing risk of death, ventricular assist device (VAD) implantation, or cardiac transplantation), they compared the rates of HFH during predefined periods before and after implantation of PAP sensor. They also compared comprehensive HF-related costs over the same time period using a nonparametric bootstrap method.
Results:
In the study cohort comprised of 1,114 HF patients receiving PAP sensor implants, there were 1,020 HFHs in the 6 months before, compared with 381 HFHs, 139 deaths, and 17 VAD implantations and/or transplants in the 6 months after implantation (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.61; p < 0.001). They found that this lower rate of HFH was associated with a 6-month comprehensive HF cost reduction of $7,433 per patient (95% CI, $7,000-$7,884), and was robust in analyses restricted to 6-month survivors. They also found similar reductions in HFH and costs in the subset of 480 patients with complete data available for 12 months before and after implantation (HR, 0.66; 95% CI, 0.57-0.76; p < 0.001). On the basis of an average Medicare reimbursement of $23,122 ± $16,891 for device implantation in this cohort, the reduction of $13,190/patient in comprehensive health care costs among survivors over 1 year suggested a break-even point of roughly 2 years to recoup the initial investment.
Conclusions:
The authors concluded that these data from the “real world” experience of Medicare implants of PAP sensors during the period following device approval support the efficacy of ambulatory hemodynamic monitoring in reducing HF hospitalization and overall costs associated with HF care.
Perspective:
In an earlier report, these authors found that ambulatory PAP reduces PAPs, and this study demonstrates that it reduces HF hospitalizations. Given its cost-effectiveness, it should be considered in eligible HF patients.
Keywords: Cardiac Surgical Procedures, Comprehensive Health Care, Cost-Benefit Analysis, Device Approval, Health Care Costs, Heart-Assist Devices, Heart Failure, Heart Transplantation, Hemodynamics, Medicare, Monitoring, Ambulatory, Primary Prevention, Pulmonary Artery
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