Key result
Implantable hemodynamic monitors reduce mortality ~25% and HF hospitalizations in HFrEF vs standard care.
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Why the study?
Prior trials and meta-analyses showed implantable hemodynamic monitors reduce HF hospitalizations but not mortality, limited by lack of patient-level data, short follow-up, and combined ejection fractions.
Does management with implantable hemodynamic monitors reduce mortality and HF hospitalizations in patients with HFrEF?
Meta-Analysis (n=1,350)
Does management with implantable hemodynamic monitors reduce mortality and HF hospitalizations in patients with HFrEF?
Hazard Ratio: 0.75 (95% CI 0.57–0.99)
p-value: p=0.043
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is the first real suggestion that managing patients by monitoring pulmonary artery pressures improves mortality in heart failure with reduced ejection fraction. It does appear that it takes longer than a year to begin to see mortality differences.”
“The real-world benefits of IHMs will likely improve with increasing experience as individual sites become more familiar with the technology and progressively refine algorithms that better align with specific patient populations, team members, and practice workflow.”
“This analysis confirms that remote pressure monitoring is a life-extending option that reduces hospitalizations and should be considered for those with this type of weak heart.”
A patient-level pooled meta-analysis demonstrates that management guided by implantable hemodynamic monitors significantly reduces both all-cause mortality and heart failure hospitalizations in patients with HFrEF.
BACKGROUND Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions. OBJECTIVES The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies. METHODS The patient-level pooled meta-analysis used 3 randomized studies (GUIDE-HF [Hemodynamic-Guided Management of Heart Failure], CHAMPION [CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients], and LAPTOP-HF [Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy]) of implantable hemodynamic monitors (2 measuring pulmonary artery pressures and 1 measuring left atrial pressure) to assess the effect on all-cause mortality and HF hospitalizations. RESULTS A total of 1,350 patients with HFrEF were included. Hemodynamic-monitoring guided management significantly reduced overall mortality with an HR of 0.75 (95% CI: 0.57-0.99); P = 0.043. HF hospitalizations were significantly reduced with an HR of 0.64 (95% CI: 0.55-0.76); P < 0.0001. CONCLUSIONS Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduces both mortality and HF hospitalizations. The reduction in HF hospitalizations is seen early in the first year of monitoring and mortality benefits occur after the first year.
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Lindenfeld et al. (2024) conducted a meta-analysis in Heart failure and reduced ejection fraction (HFrEF) (n=1,350). Implantable hemodynamic monitors was evaluated on All-cause mortality (HR 0.75, 95% CI 0.57-0.99, p=0.043). Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduced overall mortality (HR 0.75; 95% CI 0.57-0.99; P=0.043) and HF hospitalizations.
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