Ambulatory Hemodynamic Monitoring Shows Reduction in HF Hospitalizations
Use of ambulatory hemodynamic monitoring in clinical practice reduces heart failure (HF) hospitalizations and comprehensive HF costs, according to an oral abstract presented as part of ACC.17 in Washington, DC, and simultaneously published in the Journal of the American College of Cardiology.
The study, led by Akshay S. Desai, MD, MPH, FACC, et al., retrospectively examined publicly available administrative claims data from the U.S. Centers for Medicare and Medicaid Services (CMS) to compare the rates of HF hospitalizations and the costs associated with HF care in the periods before and after pulmonary artery pressure (PAP) sensor implantation.
According to the authors, the analysis of the CMS data suggests that reductions in HF hospitalizations and cost savings seen in trial populations may also be achievable in clinical practice. The 45 percent lower rate of cumulative HF hospitalizations observed at six months after PAP sensor implant vs. the six months prior to implantation compares favorably with the 28 percent reduction seen with PAP-guided therapy over the same time period in the randomized CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association functional Class III HF Patients) study that supported initial FDA approval for the device. As such, the authors argue for clinical effectiveness of ambulatory hemodynamic monitoring as a strategy for HF management.
In an accompanying editorial, Harlan M. Krumholz, MD, SM, FACC, and Sanket S. Dhruva, MD, FACC commented that the paper "responds to the great need for evidence about CardioMEMS, but unfortunately does not have the evidentiary strength to inform clinical decisions." They add that "the causal language in the authors" conclusion is not commensurate with the data available and the methods employed." Further, Krumholz and Dhruva suggest additional independent trials and more detailed observational studies.
Keywords: ACC17, ACC Annual Scientific Session, Centers for Medicare and Medicaid Services, U.S., Heart Failure, Heart Transplantation, Hemodynamics, Hospitalization, Medicare, Outpatients, Pulmonary Artery
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