title: Hemodynamic-guided heart-failure management using a wireless implantable sensor: Infrastructure, methods, and results in a community heart failure disease-management program.
abstract: BACKGROUND
  The real-world impact of remote pulmonary artery pressure (PAP) monitoring on New York Heart Association (NYHA) class improvement and heart failure (HF) hospitalization rate is presented here from a single center.
  
  
  OBJECTIVE
  METHODS: Seventy-seven previously hospitalized outpatients with NYHA class III HF were offered PAP monitoring via device implantation in a multidisciplinary HF-management program. Prospective effectiveness analyses compared outcomes in 34 hemodynamically monitored patients to a group of similar patients (n = 32) who did not undergo device implantation but received usual care. NYHA class and 6-minute walk testing were assessed at baseline and 90 days. All hospitalizations were collected after 6 months of the implantation date (average follow-up, 15 months) and compared with the number of hospitalizations experienced prior to hemodynamic monitoring.
  
  
  RESULTS
  Patients in both groups had similar distributions of age, sex, and ejection fraction. After 90 days, 61.8% of the monitored patients had NYHA class improvement of ≥1, compared with 12.5% in the controls (P < 0.001). Distance walked in 6 minutes increased by 54.5 meters in the monitored group (253.0 ± 25.6 meters to 307.4 ± 26.3 meters; P < 0.005), whereas no change was seen in the usual-care group. After implantation, 19.4% of the monitored group had ≥1 HF hospitalization, compared with 100% who had been hospitalized in the year prior to implantation. The monitored group had a significantly lower HF hospitalization rate (0.16; 95% confidence interval: 0.06-0.35 hospitalizations/patient-year) compared with the year prior (1.0 hospitalizations/patient-year; P < 0.001).
  
  
  CONCLUSIONS
  Hemodynamic-guided HF management leads to significant improvements in NYHA class and HF hospitalization rate in a real-world setting compared with usual care delivered in a comprehensive disease-management program.
authors.affiliation: Department of Medicine, Division of Cardiology, Northwell Health, Manhasset, New York.
authors.forename: Rita
authors.initials: R
authors.lastname: Jermyn
authors.affiliation: Department of Medicine, Division of Cardiology, Northwell Health, Manhasset, New York.
authors.forename: Amit
authors.initials: A
authors.lastname: Alam
authors.affiliation: Department of Medicine, Division of Cardiology, Northwell Health, Manhasset, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kvasic
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Bronx, New York.
authors.forename: Omar
authors.initials: O
authors.lastname: Saeed
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Bronx, New York.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
mesh_terms: D000368:Aged; D019468:Disease Management; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D015397:Program Evaluation; D011446:Prospective Studies; D058998:Remote Sensing Technology / Q000295:instrumentation; D013318:Stroke Volume; D017216:Telemedicine / Q000295:instrumentation*; D013997:Time Factors
keywords: Heart failure; cardiac transplantation; cardiomyopathy; myocarditis