Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in "Real-World" Clinical Practice.
BACKGROUND
In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care.


OBJECTIVE
This study examined the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of the clinical trial setting.


METHODS
We conducted a retrospective cohort study using U.S. Medicare claims data from patients undergoing pulmonary artery pressure sensor implantation between June 1, 2014, and December 31, 2015. Rates of HFH during pre-defined periods before and after implantation were compared using the Andersen-Gill extension to the Cox proportional hazards model while accounting for the competing risk of death, ventricular assist device implantation, or cardiac transplantation. Comprehensive heart failure (HF)-related costs were compared over the same periods.


RESULTS
Among 1,114 patients receiving implants, there were 1,020 HFHs in the 6 months before, compared with 381 HFHs, 139 deaths, and 17 ventricular assist device implantations and/or transplants in the 6 months after implantation (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.49 to 0.61; p < 0.001). This lower rate of HFH was associated with a 6-month comprehensive HF cost reduction of $7,433 per patient (IQR: $7,000 to $7,884), and was robust in analyses restricted to 6-month survivors. Similar reductions in HFH and costs were noted in the subset of 480 patients with complete data available for 12 months before and after implantation (HR: 0.66; 95% CI: 0.57 to 0.76; p < 0.001).


CONCLUSIONS
As in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice is associated with lower HFH and comprehensive HF costs. These benefits are sustained to 1 year and support the "real-world" effectiveness of this approach to HF management.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: adesai@partners.org.
Akshay S
AS
Desai
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
Arvind
A
Bhimaraj
Abbott, Sylmar, California.
Rupinder
R
Bharmi
Cardiology Department, St. Francis Hospital, New York, New York.
Rita
R
Jermyn
Austin Heart, Austin, Texas.
Kunjan
K
Bhatt
Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
David
D
Shavelle
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Margaret M
MM
Redfield
West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
Robert
R
Hull
Centracare Heart and Vascular Center, St. Cloud, Minnesota.
Jamie
J
Pelzel
Abbott, Sylmar, California.
Kevin
K
Davis
Abbott, Sylmar, California.
Nirav
N
Dalal
Abbott, Sylmar, California.
Philip B
PB
Adamson
Division of Cardiology, Scripps Clinic, La Jolla, California.
J Thomas
JT
Heywood
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006439:Hemodynamics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012189:Retrospective Studies
CardioMEMS; clinical effectiveness; implantable hemodynamic monitor