Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction
Document Type
Article
Publication Date
2-5-2024
Publication Title
Journal of the American College of Cardiology
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.
First Page
682
Last Page
694
PubMed ID
38325994
Volume
83
Issue
6
Recommended Citation
Lindenfeld, Jo Ann; Costanzo, Maria Rosa; Zile, Michael R.; Ducharme, Anique; Troughton, Richard; Maisel, Alan; Mehra, Mandeep R.; Paul, Sara; Sears, Samuel F.; Smart, Frank; Johnson, Nessa; Henderson, John; Adamson, Philip B.; Desai, Akshay S.; and Abraham, William T., "Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction" (2024). School of Medicine Faculty Publications. 2180.
https://digitalscholar.lsuhsc.edu/som_facpubs/2180