Abstract 13055: Ambulatory Pressure-Guided Heart Failure Management at an Advanced Heart Failure Program Shows Benefit Across Baseline Pressure Ranges
Introduction: Heart failure (HF) management guided by pulmonary artery pressure (PAP) monitoring using the CardioMEMS™ system has been shown to reduce PAP and HF hospitalization (HFH). Our aim was to examine the relationship between medical management, PAP change, and clinical outcomes in a single cohort of CardioMEMS™ patients in our advanced HF program.
Methods: We conducted retrospective analyses of PAP data (Abbott) and chart review of hospitalizations and total medication adjustments for 32 patients implanted with CardioMEMS™ at a non-transplant center. PAP change from baseline was estimated using area under the curve methodology. Rates of HFH within 6 and 12 months pre- and post-implant were compared using the Anderson-Gill regression modeling for recurrent events and presented as hazard ratio (HR) [95% CI]. Changes in PAP vs intensity of medication adjustments over time were graphed according to baseline pressure groups.
Results: Median age was 66 years (range 40-88), 50% were female, and 37.5% had preserved ejection fraction. Six patients (19%) had baseline PAP <25 mmHg, 13 patients (41%) had baseline PAP 25-35 mmHg, and 13 patients (41%) had baseline PAP ≥35 mmHg. The average change in mean PAP was -3.9±1.3 mmHg at 6 months (n=27) and -5.7±2.1 mmHg at 12 months (n=18). Adjustments in loop diuretics (53.9%, 152 adjustments) were most common. After implant, the risk of HFH decreased by 81% in 6 months (HR = 0.19 [0.10-0.37]; p<0.001) and 72% in 12 months (HR = 0.28 [0.14-0.55]; p=0.002). Patients with high baseline PAP had a high number of medication adjustments in the first 3 months, which effectively reduced PAP in subsequent months (Figure 1). Conversely, patients with low baseline PAP had increased medication adjustments and rising PAP over time.
Conclusions: PAP-guided HF management reduced PAP and HFH across pressure ranges in a real-world setting. The intensity of medication adjustments needed differed by patients’ baseline PAP.
Center for Cardiovascular Analytics, Research + Data Science (CARDS)
Abraham, Jacob; Wang, L; Lewis, Rebecca; Callis, Katherine; Remick, Joshua; and Spinelli, Kateri, "Abstract 13055: Ambulatory Pressure-Guided Heart Failure Management at an Advanced Heart Failure Program Shows Benefit Across Baseline Pressure Ranges" (2018). Articles, Abstracts, and Reports. 3480.