Remote hemodynamic monitoring reduces risk for death, HF hospitalization in HFrEF
In a meta-analysis of three trials, remote hemodynamic monitoring was associated with reduced risk for death and HF hospitalization in patients with HF with reduced ejection fraction, researchers reported.
During Technology and Heart Failure Therapeutics 2023, Cardiology Today Editorial Board Member JoAnn Lindenfeld, MD, FHFSA, professor of medicine at Vanderbilt University Medical Center, presented a meta-analysis of 1,350 patients with HFrEF (EF 40% or less at baseline; mean age, 64 years; 25% women) from the CHAMPION and GUIDE-HF trials of the CardioMEMS system (Abbott) and the LAPTOP-HF trial of the Left Atrial Pressure (LAP) Monitoring System (Abbott).
“Previous data showed that elevations in pulmonary artery pressure (PAP) is associated with increased mortality in patients with heart failure,” Lindenfeld told Healio. “Also, modest increases or decreases in estimated PA diastolic pressure are associated with increases or decreases, respectively, in mortality. We had patient-level data from three similar studies using either PAP or left atrial pressure and hypothesized that the decreases in PA and left atrial pressures would be associated with a decrease in mortality.”
At 2 years, patients assigned remote hemodynamic monitoring had a 25% RR reduction for mortality compared with controls (survival rates, 79.9% vs. 71.1%; HR = 0.75; 95% CI, 0.57-0.99; P = .04; number needed to treat to prevent one death = 11), Lindenfeld and colleagues found.
In addition, at 2 years, the remote hemodynamic monitoring group had 36% reduced risk for HF hospitalization compared with controls (HR = 0.64; 95% CI, 0.55-0.76), Lindenfeld said.
“What surprised us was the consistency of the early improvement in heart failure hospitalizations and the later appearance of a mortality benefit,” Lindenfeld told Healio. “We believe that it takes more time to show a mortality benefit like it does with implantable cardiac defibrillators, as not all patients are treated immediately.”
More evidence related to remote hemodynamic monitoring for patients with HF will emerge at the European Society of Cardiology Congress in August, when the results of the MONITOR-HF trial will be presented, she said.
“We studied HFrEF, as we had far larger numbers of patients, but we hope to see more data on hemodynamic monitoring in patients with HF [with preserved EF] to determine if there is a mortality benefit in those patients as well,” Lindenfeld told Healio. “As more data with hemodynamic monitoring are presented ... we believe these data will strengthen the overall analysis and this will spur greater use of hemodynamic monitoring in patients with HFpEF.”
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Lindenfeld J, et al. Featured Abstracts. Presented at: Technology and Heart Failure Therapeutics; March 20-22, 2023; Boston.