Patients with recurrent New York Heart Association (NYHA) Class III Heart Failure (HF) may benefit from remote hemodynamic-guided adjustment of medical therapies, according to results from a study published in the Journal of the American Heart Association.
Investigators conducted this post hoc analysis of 550 patients with NYHA Class III HF in the CHAMPION study in 2007-2009 at 64 centers in the United States. They randomly assigned patients to receive a permanent microelectromechanical sensor disc that allowed for remote monitoring (n=190) or standard assessment of pulmonary artery pressure (PAP) (n=360).
The researchers assessed patients for HF hospitalization and mortality up to 18 months on the basis of remote PAP-guided or standard management.
Participants with and without an implanted device were a mean age of 63.8±12.3 years and 60.3±13 years (P =.0039); 87.9% and 64.4% were men (P <.0001); 82.6% and 67.8% were White (P =.0002); systolic blood pressure was 117±20 mm Hg and 125±22 mm Hg (P =.0001); ejection fraction was 25%±10% and 31%±15% (P <.0001); cardiac indices were 2±0.6 and 2.2±0.6 L/min/m2 (P <.001); and 58.4% and 40% had atrial fibrillation (P <.0001), respectively.
After correcting for cohort imbalances, randomization remained significant (hazard ratio [HR], 0.71 [95% CI, 0.5-0.99]; P <.04).
Hospitalization for HF occurred at a rate of 0.46 events/patient-year (PY) among the treatment and 0.68 events/PY among the control group (HR 0.7, [95% CI, 0.51-0.96]; P =.028). Risk for HF hospitalization and mortality was reduced among the treatment group (HR, 0.72 [95% CI, 0.54-0.95]; P =.0223); however, mortality risk alone was not significantly reduced (HR, 0.77 [95% CI, 0.42-1.39]; P =.3813).
Patients in the treatment and control groups differed significantly for change in PAP at 1 (-0.9±0.4 vs 0.7±0.3 mm Hg; P <.001), 3 (-1.4±0.6 vs 0.6±0.5 mm Hg; P <.001), and 6 (-2.3±0.7 vs 0.3±0.5 mm Hg; P <.001) months.
The PAP-guided remote monitoring better controlled PAP than standard care (area under the receiver operating characteristic curve, -413.2±23.5 vs 60.1±88 mm Hg-days; P <.001), respectively.
Compared with baseline, patients in the treatment group had significantly reduced 12-month quality of life scores, as measured by the Minnesota Living With HF Questionnaire, for both emotional (change from baseline, -3.2±6.4 points; P =.03) and physical (change from baseline, -5.5±11.1 points; P =.005) scores.
Patients in the control group did not have significant reductions.
This study was biased by its significant cohort differences even after correction and by its choice to not standardize the control condition but to rely on regional standard guidelines.
The study authors concluded remote PAP-guided management better reduced PAP, HF hospitalizations, and mortality among patients with NYHA Class III HF.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Varma N, Bourge R C, Stevenson L W, et al. Remote hemodynamic-guided therapy of patients with recurrent heart failure following cardiac resynchronization therapy. J Am Heart Assoc. 2021;10(5):e017619