A pulmonary artery pressure-guided treatment algorithm that decreases filling pressures was effective for targeting changes in diuretics and vasodilators and reduced heart failure (HF) hospitalizations, according to an analysis conducted with results from the CHAMPION trial.
CHAMPION was a randomized, controlled, single-blind study that included 550 patients with HF who had an HF hospitalization within 1 year of the start of the study. Patients who underwent an implantation of the ambulatory pulmonary artery pressure monitoring system were randomly assigned to either the Active Monitoring group (pulmonary artery pressure guided HF management plus standard of care) or the Blind Therapy group (HF management by standard clinical assessment).
“The absolute rate of [HF] hospitalizations is highest with high baseline pulmonary artery pressures but the relative reduction of events with pressure-guided therapy is similar regardless of baseline pressures,” the authors wrote in their findings, published in JACC: Heart Failure.
“The CHAMPION trial has demonstrated how diuretics and vasodilators were adjusted according to pulmonary artery pressure levels to reduce [HF]-related hospitalizations compared to management based only on usual clinical assessment.”
Patients were followed for a minimum of 6 months. Researchers compared the medical therapy data between the 2 groups to determine what interventions produced significant reductions in HF hospitalizations among patients in the Active Monitoring group.
HF was associated with reduced left ventricular ejection fraction (LVEF) of ≤40% in 83% of patients (mean LVEF: 24.3% ± 8.0%) and preserved LVEF of >40% in 17% of patients (mean LVEF: 53.6% ± 8.1%).
At the start of the study, there was no difference between Active Monitoring and Blind Therapy groups in percentages of patients receiving each drug class or total daily dose equivalents for the entire study population or the reduced LVEF subgroup.
The Active Monitoring group had twice as many medication changes as the Blind Therapy group during the 6 month follow-up (2468 vs 1061; P<.0001). Diuretics were adjusted most frequently in both groups, although the number of dose changes was higher in the Active Monitoring group than the Blind Therapy group (1547 vs 585; P<.0001).
Vasodilator therapies were adjusted in 116 patients (43%) in the Active Monitoring group and 47 patients (17%) in the Blind Therapy group. Only 5% of patients with vasodilator change did not have a diuretic change, and more vasodilator changes occurred among patients in the Active Monitoring group who had higher pulmonary artery diastolic pressure.
Researchers also observed preserved renal function and significant increases in baseline doses of neurohormonal antagonists among patients in the Active Monitoring group. Individuals in this group with higher pulmonary artery pressures had intense targeted doses of diuretics and vasodilators.
The authors noted that the study “is essential to understand what interventions were triggered by pulmonary artery pressure measurements to reduce pulmonary artery pressures and hospitalizations.”
Costanzo MR, Stevenson LW, Adamson PB, et al. Interventions linked to decreased heart failure hospitalizations during ambulatory pulmonary artery pressure monitoring. JACC Heart Failure. 2016. doi: 10.1016/j.jchf.2015.11.011.