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Adamson PB, Echols M, DeFilippis EM, Morris AA, Bennett M, Abraham WT, Lindenfeld J, Teerlink JR, O'Connor CM, Connolly AT, Li H, Fiuzat M, Vaduganathan M, Vardeny O, Batchelor W, McCants KC. Clinical Trial Inclusion and Impact on Early Adoption of Medical Innovation in Diverse Populations. JACC Heart Fail 2024:S2213-1779(24)00179-3. [PMID: 38530702 DOI: 10.1016/j.jchf.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Inadequate inclusion in clinical trial enrollment may contribute to health inequities by evaluating interventions in cohorts that do not fully represent target populations. OBJECTIVES The aim of this study was to determine if characteristics of patients with heart failure (HF) enrolled in a pivotal trial are associated with who receives an intervention after approval. METHODS Demographics from 2,017,107 Medicare patients hospitalized for HF were compared with those of the first 10,631 Medicare beneficiaries who received implantable pulmonary artery pressure sensors. Characteristics of the population studied in the pivotal CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) clinical trial (n = 550) were compared with those of both groups. All demographic data were analyzed nationally and in 4 U.S. regions. RESULTS The Medicare HF cohort included 80.9% White, 13.3% African American, 1.9% Hispanic, 1.3% Asian, and 51.5% female patients. Medicare patients <65 years of age were more likely to be African American (33%) and male (58%), whereas older patients were mostly White (84%) and female (53%). Forty-one percent of U.S. HF hospitalizations occurred in the South; demographic characteristics varied significantly across all U.S. regions. The CHAMPION trial adequately represented African Americans (23% overall, 35% <65 years of age), Hispanic Americans (2%), and Asian Americans (1%) but underrepresented women (27%). The trial's population characteristics were similar to those of the first patients who received pulmonary artery sensors (82% White, 13% African American, 1% Asian, 1% Hispanic, and 29% female). CONCLUSIONS Demographics of Centers for Medicare and Medicaid Services beneficiaries hospitalized with HF vary regionally and by age, which should be considered when defining "adequate" representation in clinical studies. Enrollment diversity in clinical trials may affect who receives early application of recently approved innovations.
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Affiliation(s)
- Philip B Adamson
- Heart Failure Division, Abbott Laboratories, Austin, Texas, USA.
| | - Melvin Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Mosi Bennett
- Allina Health Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christopher M O'Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Allison T Connolly
- Global Data Science and Analytics, Abbott Laboratories, Santa Clara, California, USA
| | - Huanan Li
- Global Data Science and Analytics, Abbott Laboratories, Santa Clara, California, USA
| | - Mona Fiuzat
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Wayne Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Kelly C McCants
- Norton Heart & Vascular Institute, Norton Healthcare, Louisville, Kentucky, USA
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2
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Lindenfeld J, Costanzo MR, Zile MR, Ducharme A, Troughton R, Maisel A, Mehra MR, Paul S, Sears SF, Smart F, Johnson N, Henderson J, Adamson PB, Desai AS, Abraham WT. Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2024; 83:682-694. [PMID: 38325994 DOI: 10.1016/j.jacc.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions. OBJECTIVES The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies. METHODS The patient-level pooled meta-analysis used 3 randomized studies (GUIDE-HF [Hemodynamic-Guided Management of Heart Failure], CHAMPION [CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients], and LAPTOP-HF [Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy]) of implantable hemodynamic monitors (2 measuring pulmonary artery pressures and 1 measuring left atrial pressure) to assess the effect on all-cause mortality and HF hospitalizations. RESULTS A total of 1,350 patients with HFrEF were included. Hemodynamic-monitoring guided management significantly reduced overall mortality with an HR of 0.75 (95% CI: 0.57-0.99); P = 0.043. HF hospitalizations were significantly reduced with an HR of 0.64 (95% CI: 0.55-0.76); P < 0.0001. CONCLUSIONS Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduces both mortality and HF hospitalizations. The reduction in HF hospitalizations is seen early in the first year of monitoring and mortality benefits occur after the first year.
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Affiliation(s)
- JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | | | - Michael R Zile
- Medical University of South Carolina, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Caroline, USA
| | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Richard Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alan Maisel
- University of California San Diego, La Jolla, California, USA
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Paul
- Catawba Valley Health System, Conover, North Carolina, USA
| | - Samuel F Sears
- East Carolina University, Greenville, North Carolina, USA
| | - Frank Smart
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | | | | | - Akshay S Desai
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Benza RL, Adamson PB, Bhatt DL, Frick F, Olsson G, Bergh N, Dahlöf B. CS1, a controlled-release formulation of valproic acid, for the treatment of patients with pulmonary arterial hypertension: Rationale and design of a Phase 2 clinical trial. Pulm Circ 2024; 14:e12323. [PMID: 38174159 PMCID: PMC10763516 DOI: 10.1002/pul2.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Although rare, pulmonary arterial hypertension (PAH) is associated with substantial morbidity and a median survival of approximately 7 years, even with treatment. Current medical therapies have a primarily vasodilatory effect and do not modify the underlying pathology of the disease. CS1 is a novel oral, controlled-release formulation of valproic acid, which exhibits a multi-targeted mode of action (pulmonary pressure reduction, reversal of vascular remodeling, anti-inflammatory, anti-fibrotic, and anti-thrombotic) and therefore potential for disease modification and right ventricular modeling in patients with PAH. A Phase 1 study conducted in healthy volunteers indicated favorable safety and tolerability, with no increased risk of bleeding and significant reduction of plasminogen activator inhibitor 1. In an ongoing randomized Phase 2 clinical trial, three doses of open-label CS1 administered for 12 weeks is evaluating the use of multiple outcome measures. The primary endpoint is safety and tolerability, as measured by the occurrence of adverse events. Secondary outcome measures include the use of the CardioMEMS™ HF System, which provides a noninvasive method of monitoring pulmonary artery pressure, as well as cardiac magnetic resonance imaging and echocardiography. Other outcomes include changes in risk stratification (using the REVEAL 2.0 and REVEAL Lite 2 tools), patient reported outcomes, functional capacity, 6-min walk distance, actigraphy, and biomarkers. The pharmacokinetic profile of CS1 will also be evaluated. Overall, the novel design and unique, extensive clinical phenotyping of participants in this trial will provide ample evidence to inform the design of any future Phase 3 studies with CS1.
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Affiliation(s)
- Raymond L. Benza
- Ohio State Wexner Medical CenterThe Ohio State UniversityColumbusOhioUSA
| | | | - Deepak L. Bhatt
- Mount Sinai HeartIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Gunnar Olsson
- Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Niklas Bergh
- Institute of MedicineUniversity of GothenburgGothenburgSweden
- Early Clinical Development, Biopharmaceuticals Research and Development—CardiovascularRenal and Metabolism, AstraZenecaMölndalSweden
| | - Björn Dahlöf
- Cereno ScientificGothenburgSweden
- Institute of MedicineUniversity of GothenburgGothenburgSweden
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4
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Cowie MR, Thokala P, Ihara Z, Adamson PB, Angermann C. Real-time pulmonary artery pressure monitoring in heart failure patients: an updated cost-effectiveness analysis. ESC Heart Fail 2023; 10:3046-3054. [PMID: 37591524 PMCID: PMC10567632 DOI: 10.1002/ehf2.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS Previous cost-effectiveness analysis suggests that CardioMEMS is cost-effective compared with usual care for patients with persistent New York Heart Association class III symptoms and at least one heart failure (HF) hospitalization within 12 months. The aim of the paper is to perform an update of the cost-effectiveness analysis of CardioMEMS using the most recent data from the published literature. METHODS AND RESULTS A Microsoft Excel Markov model from a previous UK cost-effectiveness study of CardioMEMS was updated using the clinical effectiveness of pulmonary artery pressure (PAP)-guided treatment derived from the pivotal trials. The model included the device costs (and the implantation procedure and related complications), costs of remote monitoring, costs of HF-related hospitalizations, and costs of usual care. Quality-adjusted life years (QALYs) were estimated based on utilities from pivotal trials and published literature. Cost-effectiveness results were estimated as incremental cost per QALY gained of CardioMEMS compared with usual care. Scenario analyses were also performed using data from real-world studies that showed a significant decrease in HF-related hospitalizations. In the base case analysis over a time horizon of 10 years, PAP-guided HF therapy increased cost compared with usual care by £6337 (i.e. from £22 770 in usual care to £29 107 in PAP-guided HF therapy) and the QALYs per patient for usual care and PAP-guided patients were 2.62 and 2.94, respectively, reflecting an increase of 0.32 QALYs with PAP-guided treatment. The resultant incremental cost-effectiveness ratio (ICER), the ratio between incremental costs and the QALYs, is estimated at £19 761/QALY. Scenario analyses suggest that the ICER for CardioMEMS can range from being dominant to £27 910/QALY. Probabilistic sensitivity analyses suggested that PAP-guided HF therapy has 81.9% probability of being cost-effective at a threshold of £30 000/QALY. CONCLUSIONS Our model suggests that CardioMEMS is likely to be cost-effective in the United Kingdom, at the currently considered thresholds of £20 000-30 000/QALY.
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Affiliation(s)
- Martin R. Cowie
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation TrustSydney StreetLondonSW3 6NPUK
- School of Cardiovascular Medicine, Faculty of Lifesciences & MedicineKing's College LondonLondonUK
| | | | - Zenichi Ihara
- Health Economics and Reimbursement EMEA, AbbottZaventemBelgium
| | | | - Christiane Angermann
- Comprehensive Heart Failure Centre WürzburgUniversity and University Hospital WürzburgWürzburgGermany
- Department of Medicine 1University Hospital WürzburgWürzburgGermany
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5
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Desai AS, Maisel A, Mehra MR, Zile MR, Ducharme A, Paul S, Sears SF, Smart F, Bhatt K, Krim S, Henderson J, Johnson N, Adamson PB, Costanzo MR, Lindenfeld J. Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides. JACC Heart Fail 2023; 11:691-698. [PMID: 37286262 DOI: 10.1016/j.jchf.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs). OBJECTIVES This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH. METHODS In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models. RESULTS Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58). CONCLUSIONS Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813).
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Affiliation(s)
- Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. https://twitter.com/akshaydesaimd
| | - Alan Maisel
- University of California San Diego, La Jolla, California, USA
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael R Zile
- Medical University of South Carolina, RJH Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Sara Paul
- Catawba Valley Health System, Conover, North Carolina, USA
| | - Samuel F Sears
- East Carolina University, Greenville, North Carolina, USA
| | - Frank Smart
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | - Selim Krim
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | | | | | | | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
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6
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Raval NY, Valika A, Adamson PB, Williams C, Brett ME, Costanzo MR. Pulmonary Artery Pressure-Guided Heart Failure Management Reduces Hospitalizations in Patients With Chronic Kidney Disease. Circ Heart Fail 2023; 16:e009721. [PMID: 37192290 PMCID: PMC10179985 DOI: 10.1161/circheartfailure.122.009721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/31/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hemodynamic-guided heart failure management is a superior strategy to prevent decompensation leading to hospitalization compared with traditional clinical methods. It remains unstudied if hemodynamic-guided care is effective across severities of comorbid renal insufficiency or if this strategy impacts renal function over time. METHODS In the CardioMEMS US PAS (Post-Approval Study), heart failure hospitalizations were compared from 1 year before and after pulmonary artery sensor implantation in 1200 patients with New York Heart Association class III symptoms and a previous hospitalization. Hospitalization rates were evaluated in all patients grouped into baseline estimated glomerular filtration rate (eGFR) quartiles. Chronic kidney disease progression was evaluated in patients with renal function follow-up data (n=911). RESULTS Patients with stage 2 or greater chronic kidney disease at baseline exceeded 80%. Heart failure hospitalization risk was lower in all eGFR quartiles ranging from a hazard ratio of 0.35 (0.27-0.46; P<0.0001) in patients with eGFR >65 mL/min per 1.73 m2 to 0.53 (0.45-0.62; P<0.0001) in patients with eGFR ≤37 mL/min per 1.73 m2. Renal function was preserved or improved in most patients. Survival was different between quartiles and lower in quartiles with more advanced chronic kidney disease. CONCLUSIONS Hemodynamic-guided heart failure management using remotely obtained pulmonary artery pressures is associated with lower hospitalization rates and general preservation of renal function in all eGFR quartiles or chronic kidney disease stages.
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Affiliation(s)
| | - Ali Valika
- Advocate Good Samaritan Hospital, Downers Grove, IL (A.V.)
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7
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Ducharme A, Paul S, Costanzo MR, Desai AS, Maisel AS, Mehra MR, Sears S, Smart FW, Zile MR, Johnson N, Henderson J, Adamson PB, Lindenfeld J. SEX-SPECIFIC EFFECTS OF HEMODYNAMIC-GUIDED MANAGEMENT ON HEART FAILURE OUTCOMES: A POOLED ANALYSIS FROM THE CHAMPION AND GUIDE-HF TRIALS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Heywood JT, Zalawadiya S, Bourge RC, Costanzo MR, Desai AS, Rathman LD, Raval N, Shavelle DM, Henderson JD, Brett ME, Adamson PB, Stevenson LW. Sustained Reduction in Pulmonary Artery Pressures and Hospitalizations During 2 Years of Ambulatory Monitoring. J Card Fail 2023; 29:56-66. [PMID: 36332900 DOI: 10.1016/j.cardfail.2022.10.422] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/16/2022] [Accepted: 10/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapy guided by pulmonary artery (PA) pressure monitoring reduces PA pressures and heart failure hospitalizations (HFH) during the first year, but the durability of efficacy and safety through 2 years is not known. METHODS AND RESULTS The CardioMEMS Post-Approval Study investigated whether benefit and safety were generalized and sustained. Enrollment at 104 centers in the United States included 1200 patients with NYHA Class III symptoms on recommended HF therapies with prior HFH. Therapy was adjusted toward PA diastolic pressure 8-20 mmHg. Intervention frequency and PA pressure reduction were most intense during first 90 days, with sustained reduction of PA diastolic pressure from baseline 24.7 mmHg to 21.0 at 1 year and 20.8 at 2 years for all patients. Patients completing two year follow-up (n = 710) showed similar 2-year reduction (23.9 to 20.8 mmHg), with reduction in PA mean pressure (33.7 to 29.4 mmHg) in patients with reduced left ventricular ejection. The HFH rate was 1.25 events/patient/year prior to sensor implant, 0.54 at 1 year, and 0.37 at 2 years, with 59% of patients free of HFH during follow-up. CONCLUSIONS Reduction in PA pressures and hospitalizations were early and sustained during 2 years of PA pressure-guided management, with no signal of safety concerns regarding the implanted sensor.
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Affiliation(s)
- J Thomas Heywood
- Division of Cardiovascular Medicine, Scripps Green Hospital, La Jolla, CA.
| | - Sandip Zalawadiya
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Lisa D Rathman
- Cardiovascular Medicine Division, Lancaster General Hospital, Lancaster, PA
| | - Nirav Raval
- Florida Hospital Transplant Institute, Orlando, FL
| | - David M Shavelle
- MemorialCare Heart & Vascular Institute, Long Beach Medical Center, Long Beach, CA
| | | | | | | | - Lynne W Stevenson
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, TN
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9
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Assmus B, Angermann CE, Alkhlout B, Asselbergs FW, Schnupp S, Brugts JJ, Nordbeck P, Zhou Q, Brett ME, Ginn G, Adamson PB, Böhm M, Rosenkranz S. Effects of remote haemodynamic-guided heart failure management in patients with different subtypes of pulmonary hypertension: insights from the MEMS-HF study. Eur J Heart Fail 2022; 24:2320-2330. [PMID: 36054647 DOI: 10.1002/ejhf.2656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 07/17/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023] Open
Abstract
AIM The CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF) investigated safety and efficacy of pulmonary artery pressure (PAP)-guided remote patient management (RPM) in New York Heart Association (NYHA) class III outpatients with at least one heart failure hospitalization (HFH) during the previous 12 months. This pre-specified subgroup analysis investigated whether RPM effects depended on presence and subtype of pulmonary hypertension (PH). METHODS AND RESULTS In 106/234 MEMS-HF participants, Swan-Ganz catheter tracings obtained during sensor implant were available for off-line manual analysis jointly performed by two experts. Patients were classified into subgroups according to current PH definitions. Isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH) were present in 38 and 36 patients, respectively, whereas 31 patients had no PH. Clinical characteristics were comparable between subgroups, but among patients with PH pulmonary vascular resistance was higher (p = 0.029) and pulmonary artery compliance lower (p = 0.003) in patients with CpcPH. During 12 months of PAP-guided RPM, all PAPs declined in IpcPH and CpcPH subgroups (all p < 0.05), whereas only mean and diastolic PAP decreased in patients without PH (both p < 0.05). Improvements in post- versus pre-implant HFH rates were similar in CpcPH (0.639 events/patient-year; hazard ratio [HR] 0.37) and IpcPH (0.72 events/patient-year; HR 0.45) patients. Participants without PH benefited most (0.26 events/patient-year; HR 0.17, p = 0.04 vs. IpcPH/CpcPH patients). Quality of life and NYHA class improved significantly in all subgroups. CONCLUSIONS Outpatients with NYHA class III symptoms with at least one HFH during 1 year pre-implant benefitted significantly from PAP-guided RPM during post-implant follow-up irrespective of presence or subtype of PH at baseline.
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Affiliation(s)
- Birgit Assmus
- Cardiology, Department of Medicine, Goethe University Hospital, Frankfurt, Germany.,Medical Clinic I, Department of Cardiology, University Hospital Giessen, Justus Liebig University Giessen, Giessen, Germany
| | | | - Basil Alkhlout
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg-Western Pommerania, Karlsburg, Germany
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Steffen Schnupp
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology, Coburg, Germany
| | - Jasper J Brugts
- Thorax Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.,Cardiology, Department of Medicine I, Centre for Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University of Freiburg, Bad Krozingen, Germany
| | | | | | | | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine, and Cologne Cardiovascular Research Center (CCRC), University of Cologne Heart Center, Köln, Germany
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10
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Zile MR, Mehra MR, Ducharme A, Sears SF, Desai AS, Maisel A, Paul S, Smart F, Grafton G, Kumar S, Nossuli TO, Johnson N, Henderson J, Adamson PB, Costanzo MR, Lindenfeld J. Hemodynamically-Guided Management of Heart Failure Across the Ejection Fraction Spectrum. JACC: Heart Failure 2022; 10:931-944. [DOI: 10.1016/j.jchf.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
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11
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DeFilippis EM, Echols M, Adamson PB, Batchelor WB, Cooper LB, Cooper LS, Desvigne-Nickens P, George RT, Ibrahim NE, Jessup M, Kitzman DW, Leifer ES, Mendoza M, Piña IL, Psotka M, Senatore FF, Stein KM, Teerlink JR, Yancy CW, Lindenfeld J, Fiuzat M, O’Connor CM, Vardeny O, Vaduganathan M. Improving Enrollment of Underrepresented Racial and Ethnic Populations in Heart Failure Trials: A Call to Action From the Heart Failure Collaboratory. JAMA Cardiol 2022; 7:540-548. [PMID: 35319725 PMCID: PMC9098689 DOI: 10.1001/jamacardio.2022.0161] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Despite bearing a disproportionate burden of heart failure (HF), Black and Hispanic individuals have been poorly represented in HF clinical trials. Underrepresentation in clinical trials limits the generalizability of the findings to these populations and may even introduce uncertainties and hesitancy when translating trial data to the care of people from underrepresented groups. The Heart Failure Collaboratory, a consortium of stakeholders convened to enhance HF therapeutic development, has been dedicated to improving recruitment strategies for patients from diverse and historically underrepresented groups. Observations Despite federal policies from the US Food and Drug Administration and National Institutes of Health aimed at improving trial representation, gaps in trial enrollment proportionate to the racial and ethnic composition of the HF population have persisted. Increasing trial globalization with limited US enrollment is a major driver of these patterns. Additional barriers to representative enrollment include inequities in care access, logistical issues in participation, restrictive enrollment criteria, and English language requirements. Conclusions and Relevance Strategies for improving diverse trial enrollment include methodical study design and site selection, diversification of research leadership and staff, broadening of eligibility criteria, community and patient engagement, and broad stakeholder commitment. In contemporary HF trials, diverse trial enrollment is not only feasible but can be efficiently achieved to improve the generalizability and translation of trial knowledge to clinical practice.
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Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melvin Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Richard T. George
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Eric S. Leifer
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Mendoza
- Office of Minority Health, US Department of Health and Human Services (HHS), Bethesda, Maryland
| | | | | | - Fortunato Fred Senatore
- Center for Drug Evaluation and Research, Food and Drug Administration, Division of Cardiovascular and Renal Products, Silver Spring, Maryland
| | | | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | | | - Mona Fiuzat
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher M. O’Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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12
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Zile MR, Desai AS, Costanzo MR, Ducharme A, Maisel A, Mehra MR, Paul S, Sears SF, Smart F, Chien C, Guha A, Guichard JL, Hall S, Jonsson O, Johnson N, Sood P, Henderson J, Adamson PB, Lindenfeld J. OUP accepted manuscript. Eur Heart J 2022; 43:2603-2618. [PMID: 35266003 PMCID: PMC8992324 DOI: 10.1093/eurheartj/ehac114] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/27/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Aims During the coronavirus disease 2019 (COVID-19) pandemic, important changes in heart failure (HF) event rates have been widely reported, but few data address potential causes for these changes; several possibilities were examined in the GUIDE-HF study. Methods and results From 15 March 2018 to 20 December 2019, patients were randomized to haemodynamic-guided management (treatment) vs. control for 12 months, with a primary endpoint of all-cause mortality plus HF events. Pre-COVID-19, the primary endpoint rate was 0.553 vs. 0.682 events/patient-year in the treatment vs. control group [hazard ratio (HR) 0.81, P = 0.049]. Treatment difference was no longer evident during COVID-19 (HR 1.11, P = 0.526), with a 21% decrease in the control group (0.536 events/patient-year) and no change in the treatment group (0.597 events/patient-year). Data reflecting provider-, disease-, and patient-dependent factors that might change the primary endpoint rate during COVID-19 were examined. Subject contact frequency was similar in the treatment vs. control group before and during COVID-19. During COVID-19, the monthly rate of medication changes fell 19.2% in the treatment vs. 10.7% in the control group to levels not different between groups (P = 0.362). COVID-19 was infrequent and not different between groups. Pulmonary artery pressure area under the curve decreased −98 mmHg-days in the treatment group vs. −100 mmHg-days in the controls (P = 0.867). Patient compliance with the study protocol was maintained during COVID-19 in both groups. Conclusion During COVID-19, the primary event rate decreased in the controls and remained low in the treatment group, resulting in an effacement of group differences that were present pre-COVID-19. These outcomes did not result from changes in provider- or disease-dependent factors; pulmonary artery pressure decreased despite fewer medication changes, suggesting that patient-dependent factors played an important role in these outcomes. Clinical Trials.gov: NCT03387813 Key questions What factors explain the loss of treatment effect and reduction in heart failure events during COVID-19? Key findings The treatment effect change was not due to COVID-19-related events. Patient management was sustained but not intensified during COVID-19. Patient status improved during COVID-19 and pulmonary artery pressure reduced in both groups. Take home message Patient behaviour probably improved during COVID-19, given that patient status and pulmonary artery pressure improved during COVID-19 despite fewer medication changes and without increased contact from providers.
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Affiliation(s)
- Michael R. Zile
- Corresponding author. Division of Cardiology, Department of Medicine, RJH Department of Veterans Affairs Medical Center, Medical University of South Carolina, Thurmond/Gazes, Room 323, 30 Courtenay Dr, Charleston, SC 29425, USA. Tel: +1 843 792 4799, Fax: +1 843789 6850,
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Alan Maisel
- University of California San Diego, La Jolla, CA, USA
| | - Mandeep R. Mehra
- Cardiovascular Division, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Sara Paul
- Catawba Valley Health System, Conover, NC, USA
| | | | - Frank Smart
- School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Christopher Chien
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Ashrith Guha
- Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Jason L. Guichard
- Department of Medicine, Division of Cardiology, Section for Advanced Heart Failure, Pulmonary Hypertension and Mechanical Circulatory Support, Prisma Health-Upstate, Greenville, SC, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, TX, USA
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13
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Reed SD, Yang JC, Rickert T, Johnson FR, Gonzalez JM, Mentz RJ, Krucoff MW, Vemulapalli S, Adamson PB, Gebben DJ, Rincon-Gonzalez L, Saha A, Schaber D, Stein KM, Tarver ME, Bruhn-Ding D. Quantifying Benefit-Risk Preferences for Heart Failure Devices: A Stated-Preference Study. Circ Heart Fail 2021; 15:e008797. [PMID: 34937393 PMCID: PMC8763248 DOI: 10.1161/circheartfailure.121.008797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Regulatory and clinical decisions involving health technologies require judgements about relative importance of their expected benefits and risks. We sought to quantify heart-failure patients’ acceptance of therapeutic risks in exchange for improved effectiveness with implantable devices. Methods: Individuals with heart failure recruited from a national web panel or academic medical center completed a web-based discrete-choice experiment survey in which they were randomized to one of 40 blocks of 8 experimentally controlled choice questions comprised of 2 device scenarios and a no-device scenario. Device scenarios offered an additional year of physical functioning equivalent to New York Heart Association class III or a year with improved (ie, class II) symptoms, or both, with 30-day mortality risks ranging from 0% to 15%, in-hospital complication risks ranging from 0% to 40%, and a remote adjustment device feature. Logit-based regression models fit participants’ choices as a function of health outcomes, risks and remote adjustment. Results: Latent-class analysis of 613 participants (mean age, 65; 49% female) revealed that two-thirds were best represented by a pro-device, more risk-tolerant class, accepting up to 9% (95% CI, 7%–11%) absolute risk of device-associated mortality for a one-year gain in improved functioning (New York Heart Association class II). Approximately 20% were best represented by a less risk-tolerant class, accepting a maximum device-associated mortality risk of 3% (95% CI, 1%–4%) for the same benefit. The remaining class had strong antidevice preferences, thus maximum-acceptable risk was not calculated. Conclusions: Quantitative evidence on benefit-risk tradeoffs for implantable heart-failure device profiles may facilitate incorporating patients’ views during product development, regulatory decision-making, and clinical practice.
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Affiliation(s)
- Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC. (S.D.R., F.R.J., J.M.G.).,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.)
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.)
| | - Timothy Rickert
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.)
| | - F Reed Johnson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC. (S.D.R., F.R.J., J.M.G.).,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.)
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC. (S.D.R., F.R.J., J.M.G.).,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.)
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.).,Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC. (R.J.M., M.W.K., S.V.)
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.).,Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC. (R.J.M., M.W.K., S.V.)
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.D.R., J.-C.Y., T.R., F.R.J., J.M.G., R.J.M., M.W.K., S.V.).,Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC. (R.J.M., M.W.K., S.V.)
| | | | - David J Gebben
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD (D.J.G., A.S., M.E.T.)
| | | | - Anindita Saha
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD (D.J.G., A.S., M.E.T.)
| | | | | | - Michelle E Tarver
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD (D.J.G., A.S., M.E.T.)
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14
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Cowie MR, Flett A, Cowburn P, Foley P, Chandrasekaran B, Loke I, Critoph C, Gardner RS, Guha K, Betts TR, Carr-White G, Zaidi A, Lim HS, Hayward C, Patwala A, Rogers D, Pettit S, Gazzola C, Henderson J, Adamson PB. Real-world evidence in a national health service: results of the UK CardioMEMS HF System Post-Market Study. ESC Heart Fail 2021; 9:48-56. [PMID: 34882989 PMCID: PMC8787982 DOI: 10.1002/ehf2.13748] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Aims The CardioMEMS HF System Post‐Market Study (COAST) was designed to evaluate the safety, effectiveness, and feasibility of haemodynamic‐guided heart failure (HF) management using a small sensor implanted in the pulmonary artery of New York Heart Association (NYHA) Class III HF patients in the UK, Europe, and Australia. Methods and results COAST is a prospective, international, multicentre, open‐label clinical study (NCT02954341). The primary clinical endpoint compares annualized HF hospitalization rates after 1 year of haemodynamic‐guided management vs. the year prior to sensor implantation in patients with NYHA Class III symptoms and a previous HF hospitalization. The primary safety endpoints assess freedom from device/system‐related complications and pressure sensor failure after 2 years. Results from the first 100 patients implanted at 14 out of the 15 participating centres in the UK are reported here. At baseline, all patients were in NYHA Class III, 70% were male, mean age was 69 ± 12 years, and 39% had an aetiology of ischaemic cardiomyopathy. The annualized HF hospitalization rate after 12 months was 82% lower [95% confidence interval 72–88%] than the previous 12 months (0.27 vs. 1.52 events/patient‐year, respectively, P < 0.0001). Freedom from device/system‐related complications and pressure sensor failure at 2 years was 100% and 99%, respectively. Conclusions Remote haemodynamic‐guided HF management, using frequent assessment of pulmonary artery pressures, was successfully implemented at 14 specialist centres in the UK. Haemodynamic‐guided HF management was safe and significantly reduced hospitalization in a group of high‐risk patients. These results support implementation of this innovative remote management strategy to improve outcome for patients with symptomatic HF. Clinical registration number: ClinicalTrials.gov identifier: NCT02954341.
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Affiliation(s)
- Martin R Cowie
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK
| | - Andrew Flett
- University Hospital Southampton, Southampton, UK
| | | | | | | | - Ian Loke
- Glenfield Hospital, Leicester, UK
| | | | | | | | - Tim R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Amir Zaidi
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Ashish Patwala
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | | | - Stephen Pettit
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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15
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Böhm M, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett ME, Brugts JJ, Ertl G, Wang A, Hilker L, Koehler F, Rosenkranz S, Leistner DM, Abdin A, Wintrich J, Zhou Q, Adamson PB, Angermann CE. Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring. ESC Heart Fail 2021; 9:155-163. [PMID: 34738340 PMCID: PMC8787966 DOI: 10.1002/ehf2.13665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). METHODS AND RESULTS The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m2 ] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m2 , P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21). CONCLUSIONS In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Frankfurt am Main, Germany.,Department of Medicine I, Cardiology/Angiology, University Hospital, Giessen, Germany
| | - Stefan D Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology, Coburg, Germany
| | | | - Jasper J Brugts
- Erasmus MC University Medical Center, Thorax Center, Rotterdam, The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg-Western Pommerania, Karlsburg, Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine, University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC), Köln, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin, Germany
| | - Amr Abdin
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Jan Wintrich
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Bad Krozingen, Germany.,Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Christiane E Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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16
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Brinkley DM, Guglin ME, Bennett MK, Redfield MM, Abraham WT, Brett ME, Dirckx N, Adamson PB, Stevenson LW. Pulmonary Artery Pressure Monitoring Effectively Guides Management to Reduce Heart Failure Hospitalizations in Obesity. JACC Heart Fail 2021; 9:784-794. [PMID: 34509410 DOI: 10.1016/j.jchf.2021.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to determine the impact of therapy guided by pulmonary artery (PA) pressure monitoring in patients with heart failure (HF) and obesity. BACKGROUND Obesity is prevalent in HF and associated with volume retention, but it complicates clinical assessment of congestion. METHODS The CardioMEMS Post Approval Study was a prospective, multicenter, open-label trial in 1,200 patients with New York Heart Association functional class III HF and prior HF hospitalization (HFH) within 12 months. Patients with a body mass index (BMI) >35 kg/m2 were required to have a chest circumference <65 inches. Therapy was guided by PA pressure monitoring at sites, and HFHs were adjudicated 1 year before implantation and throughout follow-up. This analysis stratified patients according to ejection fraction (EF) <40% or ≥40% and by BMI <35 kg/m2 or ≥35 kg/m2. RESULTS Baseline PA diastolic pressure was higher in patients with BMI ≥35 kg/m2 regardless of EF, but all PA pressures were reduced at 12 months in each cohort (P < 0.0001). HFH rate was reduced by >50% in both cohorts for EF <40% (BMI <35 kg/m2 [HR: 0.48; 95% CI: 0.41-0.55] and ≥35 kg/m2 [HR: 0.40; 95% CI: 0.31-0.53]) and EF ≥40% (BMI <35 kg/m2 [HR: 0.42; 95% CI: 0.35-0.52] and ≥35 kg/m2 [HR: 0.34; 95% CI: 0.25-0.45]; P < 0.0001). There was a nonsignificant trend toward greater reduction with more obesity. The all-cause hospitalization rate was also significantly reduced during monitoring (P < 0.01). CONCLUSIONS Management guided by PA pressure monitoring effectively reduced pressures, HFH, and all-cause hospitalization in patients with obesity regardless of EF. (CardioMEMS HF System Post Approval Study; NCT02279888).
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Affiliation(s)
- D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Maya E Guglin
- Indiana University School of Medicine, Krannert Institute of Cardiology, Avon, Indiana, USA
| | - Mosi K Bennett
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | | | | | - Lynne W Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Lindenfeld J, Zile MR, Desai AS, Bhatt K, Ducharme A, Horstmanshof D, Krim SR, Maisel A, Mehra MR, Paul S, Sears SF, Sauer AJ, Smart F, Zughaib M, Castaneda P, Kelly J, Johnson N, Sood P, Ginn G, Henderson J, Adamson PB, Costanzo MR. Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial. Lancet 2021; 398:991-1001. [PMID: 34461042 DOI: 10.1016/s0140-6736(21)01754-2] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have suggested that haemodynamic-guided management using an implantable pulmonary artery pressure monitor reduces heart failure hospitalisations in patients with moderately symptomatic (New York Heart Association [NYHA] functional class III) chronic heart failure and a hospitalisation in the past year, irrespective of ejection fraction. It is unclear if these benefits extend to patients with mild (NYHA functional class II) or severe (NYHA functional class IV) symptoms of heart failure or to patients with elevated natriuretic peptides without a recent heart failure hospitalisation. This trial was designed to evaluate whether haemodynamic-guided management using remote pulmonary artery pressure monitoring could reduce heart failure events and mortality in patients with heart failure across the spectrum of symptom severity (NYHA funational class II-IV), including those with elevated natriuretic peptides but without a recent heart failure hospitalisation. METHODS The randomised arm of the haemodynamic-GUIDEed management of Heart Failure (GUIDE-HF) trial was a multicentre, single-blind study at 118 centres in the USA and Canada. Following successful implantation of a pulmonary artery pressure monitor, patients with all ejection fractions, NYHA functional class II-IV chronic heart failure, and either a recent heart failure hospitalisation or elevated natriuretic peptides (based on a-priori thresholds) were randomly assigned (1:1) to either haemodynamic-guided heart failure management based on pulmonary artery pressure or a usual care control group. Patients were masked to their study group assignment. Investigators were aware of treatment assignment but did not have access to pulmonary artery pressure data for control patients. The primary endpoint was a composite of all-cause mortality and total heart failure events (heart failure hospitalisations and urgent heart failure hospital visits) at 12 months assessed in all randomly assigned patients. Safety was assessed in all patients. A pre-COVID-19 impact analysis for the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT03387813. FINDINGS Between March 15, 2018, and Dec 20, 2019, 1022 patients were enrolled, with 1000 patients implanted successfully, and follow-up was completed on Jan 8, 2021. There were 253 primary endpoint events (0·563 per patient-year) among 497 patients in the haemodynamic-guided management group (treatment group) and 289 (0·640 per patient-year) in 503 patients in the control group (hazard ratio [HR] 0·88, 95% CI 0·74-1·05; p=0·16). A prespecified COVID-19 sensitivity analysis using a time-dependent variable to compare events before COVID-19 and during the pandemic suggested a treatment interaction (pinteraction=0·11) due to a change in the primary endpoint event rate during the pandemic phase of the trial, warranting a pre-COVID-19 impact analysis. In the pre-COVID-19 impact analysis, there were 177 primary events (0·553 per patient-year) in the intervention group and 224 events (0·682 per patient-year) in the control group (HR 0·81, 95% CI 0·66-1·00; p=0·049). This difference in primary events almost disappeared during COVID-19, with a 21% decrease in the control group (0·536 per patient-year) relative to pre-COVID-19, virtually no change in the treatment group (0·597 per patient-year), and no difference between groups (HR 1·11, 95% CI 0·80-1·55; p=0·53). The cumulative incidence of heart failure events was not reduced by haemodynamic-guided management (0·85, 0·70-1·03; p=0·096) in the overall study analysis but was significantly decreased in the pre-COVID-19 impact analysis (0·76, 0·61-0·95; p=0·014). 1014 (99%) of 1022 patients had freedom from device or system-related complications. INTERPRETATION Haemodynamic-guided management of heart failure did not result in a lower composite endpoint rate of mortality and total heart failure events compared with the control group in the overall study analysis. However, a pre-COVID-19 impact analysis indicated a possible benefit of haemodynamic-guided management on the primary outcome in the pre-COVID-19 period, primarily driven by a lower heart failure hospitalisation rate compared with the control group. FUNDING Abbott.
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Affiliation(s)
- JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael R Zile
- Medical University of South Carolina, RJH Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | | | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
| | - Alan Maisel
- University of California San Diego, La Jolla, CA, USA
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara Paul
- Catawba Valley Health System, Conover, NC, USA
| | | | - Andrew J Sauer
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Frank Smart
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | | | | | - Jean Kelly
- Providence Hospital, Southfield, MI, USA
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18
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DeFilippis EM, Henderson J, Axsom KM, Costanzo MR, Adamson PB, Miller AB, Brett ME, Givertz MM. Remote Hemodynamic Monitoring Equally Reduces Heart Failure Hospitalizations in Women and Men in Clinical Practice: A Sex-Specific Analysis of the CardioMEMS Post-Approval Study. Circ Heart Fail 2021; 14:e007892. [PMID: 34129363 DOI: 10.1161/circheartfailure.120.007892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Response to pharmacological and device-based therapy for heart failure (HF) may vary by sex. We examined sex differences in response to ambulatory hemodynamic monitoring in clinical practice using the CardioMEMS PAS (Post-Approval Study). METHODS The CardioMEMS PAS was a prospective, single-arm, multicenter, open-label study of 1200 adults with New York Heart Association class III HF and at least 1 HF hospitalization (HFH) within 12 months who underwent pulmonary artery pressure sensor implantation between 2014 and 2017. Changes in pulmonary artery pressure over time were stratified by ejection fraction <40% and sex. Clinical outcomes including HFH rate at 12 months, 1-year mortality, and quality of life were examined in women and men. RESULTS Four hundred fifty-two women (38% of total) enrolled in the PAS were less likely to be White (78% versus 86%) and more likely to have nonischemic cardiomyopathy (44% versus 34%) and had significantly higher SBP (132 versus 124 mm Hg), mean ejection fraction (44% versus 36%), and pulmonary vascular resistance (3.2 versus 2.6 WU) than men (P<0.001 for all). There were similar reductions in pulmonary artery pressure from baseline to 12 months in both men and women for the whole cohort and for subgroups with HF with reduced ejection fraction and HF with preserved ejection fraction. Both sexes experienced significant decreases in HFH over 12 months (men: HR, 0.46 [95% CI, 0.40-0.52]; women: HR, 0.39 [95% CI, 0.33-0.46]). In adjusted models, there were no significant differences in change in HFH between men and women (interaction P=0.13) or all-cause mortality at 1 year (adjusted HR, 1.25 [95% CI, 0.88-1.77]). CONCLUSIONS Women and men enrolled in the CardioMEMS PAS had similar reductions from baseline in pulmonary artery pressure over 1 year and experienced similar reductions in HFH. Hemodynamic monitoring provides similar benefit with regard to HF events in both women and men. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02279888.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY (E.M.D., K.M.A.)
| | | | - Kelly M Axsom
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY (E.M.D., K.M.A.)
| | | | | | - Alan B Miller
- Division of Cardiology, University of Florida, Jacksonville (A.B.M.)
| | | | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.)
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19
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Mazimba S, Ginn G, Mwansa H, Laja O, Jeukeng C, Elumogo C, Patterson B, Kennedy JLW, Mehta N, Hossack JA, Parker AM, Mihalek A, Tallaj J, Sodhi N, Kwon Y, Pamboukian SV, Adamson PB, Bilchick KC. Pulmonary Artery Proportional Pulse Pressure (PAPP) Index Identifies Patients With Improved Survival From the CardioMEMS Implantable Pulmonary Artery Pressure Monitor. Heart Lung Circ 2021; 30:1389-1396. [PMID: 33863665 DOI: 10.1016/j.hlc.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/29/2020] [Accepted: 03/07/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pulmonary artery proportional pulse pressure (PAPP) was recently shown to have prognostic value in heart failure (HF) with reduced ejection fraction (HFrEF) and pulmonary hypertension. We tested the hypothesis that PAPP would be predictive of adverse outcomes in patients with implantable pulmonary artery pressure monitor (CardioMEMS™ HF System, St. Jude Medical [now Abbott], Atlanta, GA, USA). METHODS Survival analysis with Cox proportional hazards regression was used to evaluate all-cause deaths and HF hospitalisation (HFH) in CHAMPION trial1 patients who received treatment with the CardioMEMS device based on the PAPP. RESULTS Among 550 randomised patients, 274 had PAPP ≤ the median value of 0.583 while 276 had PAPP>0.583. Patients with PAPP≤0.583 (versus PAPP>0.583) had an increased risk of HFH (HR 1.40, 95% CI 1.16-1.68, p=0.0004) and experienced a significant 46% reduction in annualised risk of death with CardioMEMS treatment (HR 0.54, 95% CI 0.31-0.92) during 2-3 years of follow-up. This survival benefit was attributable to the treatment benefit in patients with HFrEF and PAPP≤0.583 (HR 0.50, 95% CI 0.28-0.90, p<0.05). Patients with PAPP>0.583 or HF with preserved EF (HFpEF) had no significant survival benefit with treatment (p>0.05). CONCLUSION Lower PAPP in HFrEF patients with CardioMEMS constitutes a higher mortality risk status. More studies are needed to understand clinical applications of PAPP in implantable pulmonary artery pressure monitors.
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Affiliation(s)
- Sula Mazimba
- University of Virginia Health System, Charlottesville, VA, USA.
| | - Greg Ginn
- Global Research and Development, St. Jude Medical, Sylmar, CA, USA
| | - Hunter Mwansa
- Case Western Reserve University/St Vincent Charity Medical Center, Cleveland, OH, USA
| | - Olusola Laja
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - Comfort Elumogo
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | - Nishaki Mehta
- University of Virginia Health System, Charlottesville, VA, USA
| | - John A Hossack
- Department of Biomedical, Electrical and Computer Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Alex M Parker
- University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew Mihalek
- University of Virginia Health System, Charlottesville, VA, USA
| | - Jose Tallaj
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nishtha Sodhi
- University of Virginia Health System, Charlottesville, VA, USA
| | - Younghoon Kwon
- University of Washington Medical Center, Seattle, WA, USA
| | | | - Philip B Adamson
- Global Research and Development, St. Jude Medical, Sylmar, CA, USA
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Varma N, Bourge RC, Stevenson LW, Costanzo MR, Shavelle D, Adamson PB, Ginn G, Henderson J, Abraham WT. Remote Hemodynamic-Guided Therapy of Patients With Recurrent Heart Failure Following Cardiac Resynchronization Therapy. J Am Heart Assoc 2021; 10:e017619. [PMID: 33626889 PMCID: PMC8174266 DOI: 10.1161/jaha.120.017619] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patients with recurring heart failure (HF) following cardiac resynchronization therapy fare poorly. Their management is undecided. We tested remote hemodynamic‐guided pharmacotherapy. Methods and Results We evaluated cardiac resynchronization therapy subjects included in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Class III Heart Failure Patients) trial, which randomized patients with persistent New York Heart Association Class III symptoms and ≥1 HF hospitalization in the previous 12 months to remotely managed pulmonary artery (PA) pressure‐guided management (treatment) or usual HF care (control). Diuretics and/or vasodilators were adjusted conventionally in control and included remote PA pressure information in treatment. Annualized HF hospitalization rates, changes in PA pressures over time (analyzed by area under the curve), changes in medications, and quality of life (Minnesota Living with Heart Failure Questionnaire scores) were assessed. Patients who had cardiac resynchronization therapy (n=190, median implant duration 755 days) at enrollment had poor hemodynamic function (cardiac index 2.00±0.59 L/min per m2), high comorbidity burden (67% had secondary pulmonary hypertension, 61% had estimated glomerular filtration rate <60 mL/min per 1.73 m2), and poor Minnesota Living with Heart Failure Questionnaire scores (57±24). During 18 months randomized follow‐up, HF hospitalizations were 30% lower in treatment (n=91, 62 events, 0.46 events/patient‐year) versus control patients (n=99, 93 events, 0.68 events/patient‐year) (hazard ratio, 0.70; 95% CI, 0.51–0.96; P=0.028). Treatment patients had more medication up‐/down‐titrations (847 versus 346 in control, P<0.001), mean PA pressure reduction (area under the curve −413.2±123.5 versus 60.1±88.0 in control, P=0.002), and quality of life improvement (Minnesota Living with Heart Failure Questionnaire decreased −13.5±23 versus −4.9±24.8 in control, P=0.006). Conclusions Remote hemodynamic‐guided adjustment of medical therapies decreased PA pressures and the burden of HF symptoms and hospitalizations in patients with recurring Class III HF and hospitalizations, beyond the effect of cardiac resynchronization therapy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00531661.
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21
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Rathman LD, Sears S, Bourge RC, Desai AS, Heywood JT, Henderson J, Adamson PB, Brett ME, Stevenson LW. Patients Report Enhanced Control Over Their Heart Failure During Ambulatory Hemodynamic Monitoring. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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DeFilippis EM, Axsom K, Henderson J, Costanzo MR, Adamson PB, Miller AB, Brett ME, Givertz MM. Hemodynamic Monitoring Equally Reduces Heart Failure Hospitalizations in Women and Men in Clinical Practice: CardioMEMS Post-Approval Study. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Zile MR, Desai AS, Agarwal R, Bharmi R, Dalal N, Adamson PB, Maisel AS. Prognostic value of brain natriuretic peptide vs history of heart failure hospitalization in a large real-world population. Clin Cardiol 2020; 43:1501-1510. [PMID: 32949178 PMCID: PMC7724209 DOI: 10.1002/clc.23468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background In heart failure (HF) patients, both natriuretic peptides (NP) and previous HF hospitalization (pHFH) have been used to predict prognosis. Hypothesis In a large real‐world population, both NP levels and pHFH have independent and interdependent predictive value for clinical outcomes of HFH and all‐cause mortality. Methods Linked electronic health records and insurance claims data from Decision Resource Group were used to identify HF patients that had a BNP or NT‐proBNP result between January 2012 and December 2016. NT‐proBNP was converted into BNP equivalents by dividing by 4. Index event was defined as most recent NP on or after 1 January 2012. Patients with incomplete records or age < 18 years were excluded. During one‐year follow up, HFH and mortality rates stratified by index BNP levels and pHFH are reported. Results Of 64 355 patients (74 ± 12 years old, 49% female) with available values, median BNP was 259 [IQR 101‐642] pg/ml. The risk of both HFH and mortality was higher with increasing BNP levels. At each level of BNP, mortality was only slightly higher in patients with pHFH vs those without pHFH (RR 1.2 [95%CI 1.2,1.3], P < .001); however, at each BNP, HFH was markedly increased in patients with pHFH vs those without pHFH (RR 2.0 [95%CI 1.9,2.1], P < .001). Conclusion In this large real‐world heart failure population, higher BNP levels were associated with increased risk for both HFH and mortality. At any given level of BNP, pHFH added greater prognostic value for prediction of future HFH than for mortality. In heart failure (HF) patients, both natriuretic peptides (NP) and previous HF hospitalization (pHFH) have been used to predict prognosis. However, this association has not been reported over a wide range of NP levels with and without pHFH for clinical outcomes of HFH and all‐cause mortality in a large real‐world population. The current study showed that in a large real‐world heart failure population, higher BNP levels were associated with increased risk for both HFH and mortality. At any given level of BNP, pHFH added greater prognostic value for prediction of future HFH than for mortality.
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Affiliation(s)
- Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rahul Agarwal
- Abbott, Global Data Science and Analytics, Sylmar, California, USA
| | - Rupinder Bharmi
- Abbott, Global Data Science and Analytics, Sylmar, California, USA
| | - Nirav Dalal
- Abbott, Global Data Science and Analytics, Sylmar, California, USA
| | - Philip B Adamson
- Abbott, Global Data Science and Analytics, Sylmar, California, USA
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, California, USA
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24
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Angermann CE, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett M, Brugts JJ, Ertl G, Ginn G, Hilker L, Koehler F, Rosenkranz S, Zhou Q, Adamson PB, Böhm M. Pulmonary artery pressure‐guided therapy in ambulatory patients with symptomatic heart failure: the
CardioMEMS E
uropean
M
onitoring
S
tudy for
H
eart
F
ailure (
MEMS‐HF
). Eur J Heart Fail 2020; 22:1891-1901. [DOI: 10.1002/ejhf.1943] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christiane E. Angermann
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
- Department of Medicine I, Cardiology/Angiology University Hospital Giessen Germany
| | - Stefan D. Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin‐Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
| | - Folkert W. Asselbergs
- Division Heart & Lungs, Department of Cardiology University Medical Centre Utrecht Utrecht The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology Coburg Germany
| | | | - Jasper J. Brugts
- Erasmus MC University Medical Centre, Thoraxcenter Rotterdam The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg‐Western Pommerania Karlsburg Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine Charité Universitätsmedizin Berlin Berlin Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC) Cologne Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I University Heart Center Freiburg – Bad Krozingen, University of Freiburg Freiburg Germany
- Department of Cardiology University Hospital Basel Basel Switzerland
| | | | - Michael Böhm
- Internal Medicine III Cardiology, Angiology, Intensive Care Saarland University Medical Centre Homburg Germany
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25
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Shavelle DM, Desai AS, Abraham WT, Bourge RC, Raval N, Rathman LD, Heywood JT, Jermyn RA, Pelzel J, Jonsson OT, Costanzo MR, Henderson JD, Brett ME, Adamson PB, Stevenson LW. Lower Rates of Heart Failure and All-Cause Hospitalizations During Pulmonary Artery Pressure-Guided Therapy for Ambulatory Heart Failure: One-Year Outcomes From the CardioMEMS Post-Approval Study. Circ Heart Fail 2020; 13:e006863. [PMID: 32757642 PMCID: PMC7434214 DOI: 10.1161/circheartfailure.119.006863] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Supplemental Digital Content is available in the text. Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles (D.M.S.)
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D.)
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus (W.T.A.)
| | | | - Nirav Raval
- Florida Hospital Transplant Institute, Orlando (N.R.)
| | - Lisa D Rathman
- Cardiovascular Medicine Division, Lancaster General Hospital, PA (L.D.R.)
| | - J Thomas Heywood
- Division of Cardiovascular Medicine, Scripps Green Hospital, La Jolla, CA (J.T.H.)
| | - Rita A Jermyn
- Division of Cardiology, St Francis Hospital, Roslyn, NY (R.A.J.)
| | - Jamie Pelzel
- Centracare Heart and Vascular Center, St Cloud, MN (J.P.)
| | - Orvar T Jonsson
- Sanford Cardiovascular Institute, Sanford University of South Dakota Medical Center, Sioux Falls (O.T.J.)
| | | | | | | | | | - Lynne W Stevenson
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, TN (L.W.S.)
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Abraham J, Bharmi R, Jonsson O, Oliveira GH, Artis A, Valika A, Capodilupo R, Adamson PB, Roberts G, Dalal N, Desai AS, Benza RL. Association of Ambulatory Hemodynamic Monitoring of Heart Failure With Clinical Outcomes in a Concurrent Matched Cohort Analysis. JAMA Cardiol 2020; 4:556-563. [PMID: 31090869 DOI: 10.1001/jamacardio.2019.1384] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance In a randomized clinical trial, heart failure (HF) hospitalizations were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care. It remains unclear if ambulatory monitoring could also improve long-term clinical outcomes in real-world practice. Objective To determine the association between ambulatory hemodynamic monitoring and rates of HF hospitalization at 12 months in clinical practice. Design, Setting, and Participants This matched cohort study of Medicare beneficiaries used claims data collected between June 1, 2014, and March 31, 2016. Medicare patients who received implants of a pulmonary artery pressure sensor were identified from the 100% Medicare claims database. Each patient who received an implant was matched to a control patient by demographic features, history of HF hospitalization, and number of all-cause hospitalizations. Propensity scoring based on comorbidities (arrhythmia, hypertension, diabetes, pulmonary disease, and renal disease) was used for additional matching. Data analysis was completed from July 2017 through January 2019. Exposures Implantable pulmonary artery pressure monitoring system. Main Outcomes and Measures The rates of HF hospitalization were compared using the Andersen-Gill method. Days lost owing to events were compared using a nonparametric bootstrap method. Results The study cohort consisted of 1087 patients who received an implantable pulmonary artery pressure sensors and 1087 matched control patients. The treatment and control cohorts were well matched by age (mean [SD], 72.7 [10.2] years vs 72.9 [10.1] years) and sex (381 of 1087 female patients [35.1%] in each group), medical history, comorbidities, and timing of preimplant HF hospitalization. At 12 months postimplant, 616 HF hospitalizations occurred in the treatment cohort compared with 784 HF hospitalizations in the control cohort. The rate of HF hospitalization was lower in the treatment cohort at 12 months postimplant (hazard ratio [HR], 0.76 [95% CI, 0.65-0.89]; P < .001). The percentage of days lost to HF hospitalizations or death were lower in the treatment group (HR, 0.73 [95% CI, 0.64-0.84]; P < .001) and the percentage of days lost owing to all-cause hospitalization or death were also lower (HR, 0.77 [95% CI, 0.68-0.88]; P < .001). Conclusions and Relevance Patients with HF who were implanted with a pulmonary artery pressure sensor had lower rates of HF hospitalization than matched controls and spent more time alive out of hospital. Ambulatory hemodynamic monitoring may improve outcomes in patients with chronic HF.
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Affiliation(s)
- Jacob Abraham
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Portland, Oregon
| | | | | | | | | | - Ali Valika
- Advocate Heart Institute, Advocate Good Samaritan Hospital, Oakbrook Terrace, Illinois
| | | | | | | | | | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raymond L Benza
- The Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Doshi RN, Carlson S, Agarwal R, Bharmi R, Adamson PB. Association between Arrhythmia and Pulmonary Artery Pressure in Heart Failure Patients Implanted with a Cardiac Defibrillator and Ambulatory Pulmonary Artery Pressure Sensor. J Innov Card Rhythm Manag 2020; 10:3815-3821. [PMID: 32477750 PMCID: PMC7252698 DOI: 10.19102/icrm.2019.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022] Open
Abstract
The association between ventricular arrhythmia (VA) burden or defibrillator therapy and pulmonary artery pressure (PAP) has not been characterized in an ambulatory setting; thus, we sought in the present research to determine the relationship between ambulatory PAP and VA burden. A retrospective cohort study involving patients with an implantable cardiac defibrillator and CardioMEMS™ PAP sensor (Abbott Laboratories, Chicago, IL, USA) both transmitting remotely into the Merlin.net™ patient care network (Abbott Laboratories, Chicago, IL, USA) was conducted. VA and therapy burden in the six months following sensor implant were stratified by the baseline mean PAP. Patients with PAPs of 25 mmHg to 35 mmHg and those with PAPs of 35 mmHg or more were compared with individuals with PAPs of less than 25 mmHg. The change in VA burden was reported using the averaged mean PAP reduction during the first three months. A total of 162 patients aged 69.4 years ± 10.9 years were included (74% male) with a baseline mean PAP of 36.2 mmHg ± 10.4 mmHg. Twenty patients with a baseline mean PAP of less than 25 mmHg had no VAs over six months. For 61 patients with a baseline mean PAP of between 25 mmHg and 35 mmHg, the annualized number of days with ventricular tachycardia (VT)/ventricular fibrillation (VF) was 1.65/patient-year (p < 0.001), with 8% of patients having VT/VF events. For 81 patients with a baseline mean PAP of 35 mmHg or more, 19% of patients had a VT/VF event and an annualized number of days with VT/VF events of 1.45/patient-year (p < 0.001). When analyzing the treatment effect, a reduction of 3 mmHg or more in mean PAP over three months reduced arrhythmia burden over the next three months as compared with in patients without such an improvement. In conclusion, it is indicated that VAs are associated with high PAPs, and a reduction in PAP may lead to a reduction in VAs in real-world ambulatory patients.
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Affiliation(s)
- Rahul N Doshi
- University of Southern California, Los Angeles, CA, USA
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Cowie MR, de Groote P, McKenzie S, Brett M, Adamson PB. Rationale and design of the CardioMEMS Post-Market Multinational Clinical Study: COAST. ESC Heart Fail 2020; 7:865-872. [PMID: 32031758 PMCID: PMC7261560 DOI: 10.1002/ehf2.12646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Chronic heart failure reduces quality and quantity of life and is expensive for healthcare systems. Medical treatment relies on guideline-directed therapy, but clinical follow-up and remote management is highly variable and poorly effective. New remote management strategies are needed to maintain clinical stability and avoid hospitalizations for acute decompensation. METHODS AND RESULTS The CardioMEMS Post-Market Study is a prospective, international, single-arm, multicentre, open-label study (NCT02954341) designed to examine the feasibility of haemodynamic guided heart failure management using a small pressure sensor permanently implanted in the pulmonary artery (PA). Daily uploaded PA pressures will be reviewed weekly to remotely guide medical management of patients with persistent NYHA Class III symptoms at baseline and a hospitalization in the prior 12 months. The study will enrol up to 800 patients from 85 sites across the United Kingdom, Europe, and Australia. The primary safety endpoint will assess device or system-related complications or sensor failures after 2 years of follow-up. Efficacy will be estimated after 1 year of follow-up comparing HF hospitalization rates before and after sensor implantation. Observational endpoints will include mortality, patient, and investigator monitoring compliance, PA pressure changes, quality of life, and several pre-defined subgroup analyses. CONCLUSIONS The CardioMEMS Post-Market Study will investigate the generalizability of remote haemodynamic guided HF management in a number of national settings. The results may support the more widespread implementation of this novel clinical management approach.
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Affiliation(s)
- Martin R. Cowie
- Royal Brompton HospitalImperial College LondonSydney StreetLondonSW3 6LYUK
| | - Pascal de Groote
- Pôle Cardio‐Vasculaire et Pulmonaire, Hôpital Albert CalmetteCHRU de LilleBoulevard du Pr. Jules Leclercq59037Lille CEDEXFrance
| | - Scott McKenzie
- The Prince Charles Hospital and Holy Spirit Northside HospitalUniversity of QueenslandRode RoadChermsideQLD4032Australia
| | - Marie‐Elena Brett
- Heart Failure DivisionAbbott15900 Valley View Ct.SylmarCA91342United States
| | - Philip B. Adamson
- Heart Failure DivisionAbbott15900 Valley View Ct.SylmarCA91342United States
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Brinkley DM, Guglin M, Bennett M, Redfield MM, Abraham W, Brett ME, Dirckx N, Adamson PB, Stevenson L. PULMONARY ARTERY PRESSURE MONITORING EFFECTIVELY GUIDES MANAGEMENT TO REDUCE HEART FAILURE HOSPITALIZATIONS IN PATIENTS WITH OBESITY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lindenfeld J, Abraham WT, Maisel A, Zile M, Smart F, Costanzo MR, Mehra MR, Ducharme A, Sears SF, Desai AS, Paul S, Sood P, Johnson N, Ginn G, Adamson PB. Hemodynamic-GUIDEd management of Heart Failure (GUIDE-HF). Am Heart J 2019; 214:18-27. [PMID: 31150790 DOI: 10.1016/j.ahj.2019.04.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
Affiliation(s)
- JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States
| | - Alan Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs San Diego Healthcare, San Diego, CA, United States
| | - Michael Zile
- Division of Cardiology, Department of Medicine, RHJ Department of Veterans Affairs Medical Center and the Medical University of South Carolina, Charleston, SC, United States
| | - Frank Smart
- Cardiovascular Center of Excellence, Department of Medicine, Division of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Samuel F Sears
- Department(s) of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Akshay S Desai
- Center for Advanced Heart Disease, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Paul
- Heart Function Program, Catawba Valley Cardiology, Conover, NC, United States
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Veenis JF, Manintveld OC, Constantinescu AA, Caliskan K, Birim O, Bekkers JA, van Mieghem NM, den Uil CA, Boersma E, Lenzen MJ, Zijlstra F, Abraham WT, Adamson PB, Brugts JJ. Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO-VAD pilot study. ESC Heart Fail 2019; 6:194-201. [PMID: 30614639 PMCID: PMC6351888 DOI: 10.1002/ehf2.12392] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/16/2018] [Accepted: 11/05/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS We aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD). METHODS AND RESULTS In this single-centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2-5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post-LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients. CONCLUSIONS The HEMO-VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | | | | | - Kadir Caliskan
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | | | - Corstiaan A den Uil
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands.,Department of Intensive Care Medicine, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Colombus, OH, USA
| | - Philip B Adamson
- Division of Cardiology, Oklahoma Foundation for Cardiovascular Research, Oklahoma City, OK, USA
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
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Angermann CE, Assmus B, Anker SD, Brachmann J, Ertl G, Köhler F, Rosenkranz S, Tschöpe C, Adamson PB, Böhm M. Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol 2018; 107:991-1002. [PMID: 29777373 DOI: 10.1007/s00392-018-1281-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Wireless monitoring of pulmonary artery (PA) pressures with the CardioMEMS HF™ system is indicated in patients with New York Heart Association (NYHA) class III heart failure (HF). Randomized and observational trials have shown a reduction in HF-related hospitalizations and improved quality of life in patients using this device in the United States. OBJECTIVE MEMS-HF is a prospective, non-randomized, open-label, multicenter study to characterize safety and feasibility of using remote PA pressure monitoring in a real-world setting in Germany, The Netherlands and Ireland. METHODS AND RESULTS After informed consent, adult patients with NYHA class III HF and a recent HF-related hospitalization are evaluated for suitability for permanent implantation of a CardioMEMS™ sensor. Participation in MEMS-HF is open to qualifying subjects regardless of left ventricular ejection fraction (LVEF). Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy as tolerated. The study will enroll 230 patients in approximately 35 centers. Expected duration is 36 months (24-month enrolment plus ≥ 12-month follow-up). Primary endpoints are freedom from device/system-related complications and freedom from pressure sensor failure at 12-month post-implant. Secondary endpoints include the annualized rate of HF-related hospitalization at 12 months versus the rate over the 12 months preceding implant, and health-related quality of life. Endpoints will be evaluated using data obtained after each subject's 12-month visit. CONCLUSIONS The MEMS-HF study will provide robust evidence on the clinical safety and feasibility of implementing haemodynamic monitoring as a novel disease management tool in routine out-patient care in selected European healthcare systems. TRIAL REGISTRATION ClinicalTrials.gov; NCT02693691.
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Affiliation(s)
- Christiane E Angermann
- Department of Medicine I, Cardiology, and Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism and Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology & Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | | | - Georg Ertl
- Department of Medicine I, Cardiology, and Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | | | | | | | | | - Michael Böhm
- Saarland University Medical Center, Homburg, Germany
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Joly J, Heywood T, Shavelle D, Bourge RC, Costanzo MR, Shlofmitz R, Adamson PB, Desai AS, Rathman LD, Abraham WT, Stevenson LW. Front-Loaded Intervention during First 90 Days of Pulmonary Pressure Guided Management. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Adamson PB, Abraham WT, Stevenson LW, Desai AS, Lindenfeld J, Bourge RC, Bauman J. Pulmonary Artery Pressure-Guided Heart Failure Management Reduces 30-Day Readmissions. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002600. [PMID: 27220593 DOI: 10.1161/circheartfailure.115.002600] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients. METHODS AND RESULTS The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080). CONCLUSIONS Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT00531661.
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Affiliation(s)
- Philip B Adamson
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.).
| | - William T Abraham
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Lynne Warner Stevenson
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Akshay S Desai
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - JoAnn Lindenfeld
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Robert C Bourge
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Jordan Bauman
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
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Martinson M, Bharmi R, Dalal N, Abraham WT, Adamson PB. Pulmonary artery pressure-guided heart failure management: US cost-effectiveness analyses using the results of the CHAMPION clinical trial. Eur J Heart Fail 2017; 19:652-660. [PMID: 27647784 PMCID: PMC5434920 DOI: 10.1002/ejhf.642] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
AIMS Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study. METHODS AND RESULTS An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality-adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5-year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost-effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non-HF hospitalizations, physician visits, prescription drugs, long-term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY. CONCLUSIONS Standard economic modelling suggests that pulmonary artery pressure-guided management of HF using the CardioMEMS™ HF System is cost-effective from the US-payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures.
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Affiliation(s)
- Melissa Martinson
- Technomics ResearchLLCMinneapolisMNUSA
- University of Minnesota School of Public HealthMinneapolisMNUSA
- St. Cloud State University Graduate SchoolSt. CloudMNUSA
| | - Rupinder Bharmi
- Clinical Research and DevelopmentSt. Jude Medical, Inc.SylmarCAUSA
| | - Nirav Dalal
- Clinical Research and DevelopmentSt. Jude Medical, Inc.SylmarCAUSA
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Abraham WT, Adamson PB, Costanzo MR, Eigler N, Gold M, Klapholz M, Maurer M, Saxon L, Singh J, Troughton R. Hemodynamic Monitoring in Advanced Heart Failure: Results from the LAPTOP-HF Trial. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adamson PB, Ginn G, Anker SD, Bourge RC, Abraham WT. Remote haemodynamic-guided care for patients with chronic heart failure: a meta-analysis of completed trials. Eur J Heart Fail 2016; 19:426-433. [DOI: 10.1002/ejhf.638] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 07/07/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Philip B. Adamson
- Global Research and Development, St. Jude Medical; Sylmar CA USA
- Department of Physiology; University of Oklahoma Health Sciences Center; Oklahoma City OK USA
| | - Greg Ginn
- Global Research and Development, St. Jude Medical; Sylmar CA USA
| | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - Robert C. Bourge
- Division of Cardiovascular Disease; University of Alabama; Birmingham AL USA
| | - William T. Abraham
- Division of Cardiovascular Medicine; The Ohio State University; Columbus OH USA
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Adamson PB, Roberts GJ, Gu NY, Bharmi R, Desai AS, Abraham WT. Economic Impact of Hemodynamic Monitoring in Heart Failure Patients: Estimating the Number-Needed-to-Treat and the Break-Even-Point Using a Claims Database. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abraham WT, Jermyn R, Shavelle D, Bimaraj A, Bhatt K, Sheikh F, Eichorn E, Heywood JT, Lamba S, Bharmi R, Agarwal R, Adamson PB, Stevenson LW. Pulmonary Artery Pressures Decrease Over Time during Heart Failure Management Guided by Ambulatory Hemodynamic Monitoring in Real World Setting. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kolominsky-Rabas PL, Kriza C, Djanatliev A, Meier F, Uffenorde S, Radeleff J, Baumgärtel P, Leb I, Sedlmayr M, Gaiser S, Adamson PB. Health Economic Impact of a Pulmonary Artery Pressure Sensor for Heart Failure Telemonitoring: A Dynamic Simulation. Telemed J E Health 2016; 22:798-808. [PMID: 27285946 DOI: 10.1089/tmj.2015.0226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Recently, a permanently implantable wireless system, designed to monitor and manage pulmonary artery (PA) pressures remotely, demonstrated significant reductions in heart failure (HF) hospitalizations in high-risk symptomatic patients, regardless of ejection fraction. The objectives of this study were to simulate the estimated clinical and economic impact in Germany of generalized use of this PA pressure monitoring system considering reductions of HF hospitalizations and the improvement in Quality of Life. MATERIALS AND METHODS Based on the Prospective Health Technology Assessment approach, we simulated the potential of the widespread application of PA pressure monitoring on the German healthcare system for the period 2009-2021. RESULTS This healthcare economic simulation formulated input assumptions based on results from the CHAMPION Trial, a multicenter, prospective, randomized controlled U.S. trial that demonstrated a 37% reduction of hospitalizations in persistently symptomatic previous HF patients. Based on these results, an estimated 114,800 hospitalizations would expected to be avoided. This effect would potentially save an estimated €522 million, an equivalent of $575 million, during the entire simulation period. CONCLUSION This healthcare economic modeling of the PA pressure monitoring system's impact demonstrates substantial clinical and economic benefits in the German healthcare system.
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Affiliation(s)
- Peter L Kolominsky-Rabas
- 1 Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany .,2 National Cluster of Excellence, Medical Technologies-Medical Valley EMN' , Erlangen, Germany
| | - Christine Kriza
- 1 Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany .,2 National Cluster of Excellence, Medical Technologies-Medical Valley EMN' , Erlangen, Germany
| | - Anatoli Djanatliev
- 3 Chair of Computer Science 7-Computer Networks and Communication Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Florian Meier
- 4 School of Business and Economics, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | | | | | - Philipp Baumgärtel
- 6 Chair of Computer Science 6-Data management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Ines Leb
- 7 Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Martin Sedlmayr
- 7 Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Sebastian Gaiser
- 8 St. Jude Medical, Coordination Center BVBA , Zaventem, Belgium
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Kolominsky-Rabas PL, Kriza C, Djanatliev A, Meier F, Uffenorde S, Radeleff J, Baumgärtel P, Leb I, Sedlmayr M, Gaiser S, Adamson PB. Health Economic Impact of a Pulmonary Artery Pressure Sensor for Heart Failure Telemonitoring: A Dynamic Simulation. Telemed J E Health 2016. [DOI: 10.1089/tmj.2015.0226.rev] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter L. Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
- National Cluster of Excellence, Medical Technologies—Medical Valley EMN’, Erlangen, Germany
| | - Christine Kriza
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
- National Cluster of Excellence, Medical Technologies—Medical Valley EMN’, Erlangen, Germany
| | - Anatoli Djanatliev
- Chair of Computer Science 7–Computer Networks and Communication Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
| | - Florian Meier
- School of Business and Economics, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
| | | | | | - Philipp Baumgärtel
- Chair of Computer Science 6–Data management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
| | - Ines Leb
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
| | - Martin Sedlmayr
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Germany
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Abraham WT, Stevenson LW, Bourge RC, Lindenfeld JA, Bauman JG, Adamson PB. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet 2016; 387:453-61. [PMID: 26560249 DOI: 10.1016/s0140-6736(15)00723-0] [Citation(s) in RCA: 413] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In the CHAMPION trial, significant reductions in admissions to hospital for heart failure were seen after 6 months of pulmonary artery pressure guided management compared with usual care. We examine the extended efficacy of this strategy over 18 months of randomised follow-up and the clinical effect of open access to pressure information for an additional 13 months in patients formerly in the control group. METHODS The CHAMPION trial was a prospective, parallel, single-blinded, multicentre study that enrolled participants with New York Heart Association (NYHA) Class III heart failure symptoms and a previous admission to hospital. Patients were randomly assigned (1:1) by centre in block sizes of four by a secure validated computerised randomisation system to either the treatment group, in which daily uploaded pulmonary artery pressures were used to guide medical therapy, or to the control group, in which daily uploaded pressures were not made available to investigators. Patients in the control group received all standard medical, device, and disease management strategies available. Patients then remained masked in their randomised study group until the last patient enrolled completed at least 6 months of study follow-up (randomised access period) for an average of 18 months. During the randomised access period, patients in the treatment group were managed with pulmonary artery pressure and patients in the control group had usual care only. At the conclusion of randomised access, investigators had access to pulmonary artery pressure for all patients (open access period) averaging 13 months of follow-up. The primary outcome was the rate of hospital admissions between the treatment group and control group in both the randomised access and open access periods. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. FINDINGS Between Sept 6, 2007, and Oct 7, 2009, 550 patients were randomly assigned to either the treatment group (n=270) or to the control group (n=280). 347 patients (177 in the former treatment group and 170 in the former control group) completed the randomised access period in August, 2010, and transitioned to the open access period which ended April 30, 2012. Over the randomised access period, rates of admissions to hospital for heart failure were reduced in the treatment group by 33% (hazard ratio [HR] 0·67 [95% CI 0·55-0·80]; p<0·0001) compared with the control group. After pulmonary artery pressure information became available to guide therapy during open access (mean 13 months), rates of admissions to hospital for heart failure in the former control group were reduced by 48% (HR 0·52 [95% CI 0·40-0·69]; p<0·0001) compared with rates of admissions in the control group during randomised access. Eight (1%) device-related or system related complications and seven (1%) procedure-related adverse events were reported. INTERPRETATION Management of NYHA Class III heart failure based on home transmission of pulmonary artery pressure with an implanted pressure sensor has significant long-term benefit in lowering hospital admission rates for heart failure. FUNDING St Jude Medical Inc.
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Affiliation(s)
- William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
| | - Lynne W Stevenson
- Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert C Bourge
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jordan G Bauman
- Global Research and Development, St Jude Medical, Austin, TX, USA
| | - Philip B Adamson
- Global Research and Development, St Jude Medical, Austin, TX, USA
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Adamson PB, Bharmi R, Dalal N, Abraham WT. Impact of Pulmonary Artery Pressure Monitoring on All-cause 30-day HF Readmissions and Associated Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program Penalty. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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St. John Sutton M, Plappert T, Adamson PB, Li P, Christman SA, Chung ES, Curtis AB. Left Ventricular Reverse Remodeling With Biventricular Versus Right Ventricular Pacing in Patients With Atrioventricular Block and Heart Failure in the BLOCK HF Trial. Circ Heart Fail 2015; 8:510-8. [DOI: 10.1161/circheartfailure.114.001626] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/13/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Martin St. John Sutton
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Ted Plappert
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Philip B. Adamson
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Pei Li
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Shelly A. Christman
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Eugene S. Chung
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
| | - Anne B. Curtis
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (M.S.S., T.P.); Department of Medicine, Oklahoma Heart Hospital, Oklahoma City (P.B.A.); Medtronic, Inc, Mounds View, MN (P.L., S.A.C.); Department of Medicine, Ohio Heart and Vascular Center, Cincinnati (E.S.C.); and Department of Medicine, University at Buffalo, NY (A.B.C.)
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Maurer MS, Adamson PB, Costanzo MR, Eigler N, Gilbert J, Gold MR, Klapholz M, Saxon LA, Singh JP, Troughton R, Abraham WT. Rationale and Design of the Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy Study (LAPTOP-HF). J Card Fail 2015; 21:479-88. [PMID: 25921522 DOI: 10.1016/j.cardfail.2015.04.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Daily measurements of left atrial pressure (LAP) may be useful for guiding adjustments in medical therapy that prevent clinical decompensation in patients with severe heart failure (HF). STUDY DESIGN LAPTOP-HF is a prospective, multicenter, randomized, controlled clinical trial in ambulatory patients with advanced heart failure in which the safety and clinical effectiveness of a physician-directed patient self-management therapeutic strategy based on LAP measured twice daily by means of an implantable sensor will be compared with a control group receiving optimal medical therapy. The trial will enroll up to 730 patients with New York Heart Association functional class III symptoms and either a hospitalization for HF during the previous 12 months or an elevated B-type natriuretic peptide level, regardless of ejection fraction, at up to 75 investigational centers. Randomization to the treatment group or control group will be at a 1:1 ratio in 3 strata based on the ejection fraction (EF > or ≤35%) and the presence of a de novo CRT device indication. SUMMARY LAPTOP-HF will provide essential information about the role of implantable LAP monitoring in conjunction with a new HF treatment paradigm across the spectrum of HF patients.
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Affiliation(s)
- Mathew S Maurer
- Columbia University Medical Center, Allen Hospital of New York Presbyterian Hospital, New York, New York.
| | - Philip B Adamson
- Heart Failure Institute at Oklahoma Heart Hospital and Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; St. Jude Medical, Sylmar, California
| | | | - Neal Eigler
- Consultant, Global Clinical Affairs, St. Jude Medical, Sylmar, California
| | | | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Marc Klapholz
- Division of Cardiovascular Diseases, Rutgers, The State University of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - Leslie A Saxon
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jagmeet P Singh
- Harvard Medical School, Cardiology Division, Electrophysiology Laboratory, Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard Troughton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
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Krahnke JS, Abraham WT, Adamson PB, Bourge RC, Bauman J, Ginn G, Martinez FJ, Criner GJ. Heart failure and respiratory hospitalizations are reduced in patients with heart failure and chronic obstructive pulmonary disease with the use of an implantable pulmonary artery pressure monitoring device. J Card Fail 2015; 21:240-9. [PMID: 25541376 PMCID: PMC4405122 DOI: 10.1016/j.cardfail.2014.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). Elevated pulmonary arterial (PA) pressure can be seen in both conditions and has been shown to predict morbidity and mortality. METHODS AND RESULTS A total of 550 subjects with New York Heart Association functional class III HF were randomly assigned to the treatment (n = 270) and control (n = 280) groups in the CHAMPION Trial. Physicians had access to the PA pressure measurements in the treatment group only, in which HF therapy was used to lower the elevated pressures. HF and respiratory hospitalizations were compared in both groups. A total of 187 subjects met criteria for classification into the COPD subgroup. In the entire cohort, the treatment group had a 37% reduction in HF hospitalization rates (P < .0001) and a 49% reduction in respiratory hospitalization rates (P = .0061). In the COPD subgroup, the treatment group had a 41% reduction in HF hospitalization rates (P = .0009) and a 62% reduction in respiratory hospitalization rates (P = .0023). The rate of respiratory hospitalizations in subjects without COPD was not statistically different (P = .76). CONCLUSIONS HF management incorporating hemodynamic information from an implantable PA pressure monitor significantly reduces HF and respiratory hospitalizations in HF subjects with comorbid COPD compared with standard care.
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Affiliation(s)
- Jason S Krahnke
- Temple University School of Medicine, Philadelphia, Pennsylvania.
| | | | - Philip B Adamson
- Oklahoma Heart Hospital and Oklahoma Foundation for Cardiovascular Research, Oklahoma City, Oklahoma
| | | | | | | | | | - Gerard J Criner
- Temple University School of Medicine, Philadelphia, Pennsylvania
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Benza RL, Raina A, Abraham WT, Adamson PB, Lindenfeld J, Miller AB, Bourge RC, Bauman J, Yadav J. Pulmonary hypertension related to left heart disease: Insight from a wireless implantable hemodynamic monitor. J Heart Lung Transplant 2015; 34:329-37. [DOI: 10.1016/j.healun.2014.04.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/24/2014] [Accepted: 04/30/2014] [Indexed: 11/25/2022] Open
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Raina A, Abraham WT, Adamson PB, Bauman J, Benza RL. Limitations of right heart catheterization in the diagnosis and risk stratification of patients with pulmonary hypertension related to left heart disease: insights from a wireless pulmonary artery pressure monitoring system. J Heart Lung Transplant 2015; 34:438-47. [PMID: 25813770 DOI: 10.1016/j.healun.2015.01.983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/15/2015] [Accepted: 01/31/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although right heart catheterization (RHC) remains the gold standard for assessment of hemodynamics in patients with known or suspected pulmonary hypertension (PH), there are significant limitations to this type of assessment. The current study evaluates the limitations of RHC in the diagnosis of left heart-related PH (World Health Organization group II) among patients enrolled in the CHAMPION trial and discusses insights into patient risk from home implantable hemodynamic monitor (IHM) data that were not identified at the time of the RHC procedure. METHODS The CHAMPION trial enrolled 550 New York Heart Association functional class III patients who had been hospitalized for heart failure (HF) in the previous year, regardless of left ventricular ejection fraction or etiology. Hemodynamic data obtained during baseline RHC were compared with IHM data obtained during the first week of home readings. HF hospitalization rates and mortality were analyzed to assess patient risk. RESULTS The study population for this retrospective analysis comprised 537 patients with available IHM data. For 320 patients in the PHRHC group, home IHM data confirmed the RHC findings with similar mean pulmonary artery pressures obtained from both methods (36 mm Hg vs 36 mm Hg, p = 0.5066). However, of the 217 patients in the No PHRHC group, 106 patients (48.8%) exhibited PH based on the home IHM data (PHIHM group). The remaining 111 patients (51.2%) in the No PHRHC group had no evidence of PH on the IHM data (No PHIHM group). Patients in the No PHRHC/PHIHM group had significantly higher mean PA pressures on IHM than patients in the No PHRHC/No PHIHM group (31 mm Hg vs 18 mm Hg, p < 0.0001). Patients in the No PHRHC/No PHIHM group had significantly lower HF hospitalization rates than patients in the No PHRHC/PHIHM group (0.25 vs 0.49, incidence rate ratio = 0.51, 95% confidence interval = 0.33-0.77, p = 0.0007). CONCLUSIONS Using only RHC, World Health Organization group II PH may be significantly under-diagnosed. In patients with left-sided HF and resting mean PA pressure ≤25 mm Hg during RHC, more frequent PA pressure monitoring using an IHM device can provide additional data for improved diagnosis and patient risk stratification compared with a single RHC alone.
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Affiliation(s)
- Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania.
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | - Philip B Adamson
- Heart Failure Institute at Oklahoma Heart Hospital and Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Raymond L Benza
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Adamson PB, Abraham WT, Bourge RC, Costanzo MR, Hasan A, Yadav C, Henderson J, Cowart P, Stevenson LW. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail 2014; 7:935-44. [PMID: 25286913 DOI: 10.1161/circheartfailure.113.001229] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND No treatment strategies have been demonstrated to be beneficial for the population for patients with heart failure (HF) and preserved ejection fraction (EF). METHODS AND RESULTS The CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial was a prospective, single-blinded, randomized controlled clinical trial testing the hypothesis that hemodynamically guided HF management decreases decompensation leading to hospitalization. Of the 550 patients enrolled in the study, 119 had left ventricular EF ≥40% (average, 50.6%), 430 patients had low left ventricular EF (<40%; average, 23.3%), and 1 patient had no documented left ventricular EF. A microelectromechanical system pressure sensor was permanently implanted in all participants during right heart catheterization. After implant, subjects were randomly assigned in single-blind fashion to a treatment group in whom daily uploaded pressures were used in a treatment strategy for HF management or to a control group in whom standard HF management included weight-monitoring, and pressures were uploaded but not available for investigator use. The primary efficacy end point of HF hospitalization rate >6 months for preserved EF patients was 46% lower in the treatment group compared with control (incidence rate ratio, 0.54; 95% confidence interval, 0.38-0.70; P<0.0001). After an average of 17.6 months of blinded follow-up, the hospitalization rate was 50% lower (incidence rate ratio, 0.50; 95% confidence interval, 0.35-0.70; P<0.0001). In response to pulmonary artery pressure information, more changes in diuretic and vasodilator therapies were made in the treatment group. CONCLUSIONS Hemodynamically guided management of patients with HF with preserved EF reduced decompensation leading to hospitalization compared with standard HF management strategies. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00531661.
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Affiliation(s)
- Philip B Adamson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.).
| | - William T Abraham
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Robert C Bourge
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Maria Rosa Costanzo
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Ayesha Hasan
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Chethan Yadav
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - John Henderson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Pam Cowart
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Lynne Warner Stevenson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
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Abraham WT, Adamson PB, Stevenson LW, Yadav J. Benefits of Pulmonary Artery Pressure Monitoring in Patients with NYHA Class III Heart Failure and Chronic Kidney Disease: Results from the CHAMPION Trial. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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