Ambulatory haemodynamic-guided management reduces heart failure hospitalizations in a multicentre European heart failure cohort

Abstract

Aims: To investigate the outcomes and associated costs of haemodynamic-guided heart failure (HF) management with a pulmonary artery pressure (PAP) sensor in a multicentre European cohort.

Methods and results: Data from all consecutive patients receiving a PAP sensor in Ziekenhuis Oost-Limburg, University Hospital Zurich and Sheffield Teaching Hospitals NHS Foundation Trust before January 2021 were collected. Medication changes, total number of HF hospitalizations and HF related health care costs (composed of HF hospitalizations, outpatient cardiology visits and monitoring costs) were compared between the pre-implantation and post-implantation period at 3, 6, and 12 months. PAP evolution post-implantation were grouped according to baseline mPAP ≥25 mmHg versus <25 mmHg and changes from baseline were analyzed via an area under the curve (AUC) analysis. A total of 48 patients received a PAP sensor (29 CardioMEMS and 19 Cordella devices) with a median follow-up of 19 (13-30) months. Mean age was 71 ± 10 years, 25.0% were female, 68.8% had a left ventricular ejection fraction < 50%, median NT-proBNP was 1801 (827-4503) pg/mL, and 89.6% were in NYHA class III. The number of diuretic therapy changes were non-significantly increased after 3 months (49 vs. 82; P = 0.284) and 6 months (82 vs. 127; P = 0.093) with a significant increase noted after 12 months (118 vs. 195; P = 0.005). The mPAP AUC decreased by -1418 mmHg-days for patients with a baseline mean PAP ≥ 25 mmHg. The number of HF hospitalizations was reduced for all patients after 6 (34 vs. 17; P = 0.014) and 12 months (48 vs. 29; P = 0.032). HF related health care costs were reduced from € 6286 to € 3761 at 6 months (P = 0.012) and from € 8960 to € 6167 at 12 months (P = 0.032).

Conclusion: Haemodynamic-guided HF management reduces HF hospitalizations and HF related health care costs in selected HF patients amongst different European health care systems.

Keywords: Diuretics; Health care costs; Heart failure; Pulmonary artery pressure monitoring; Telemonitoring.