Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction
Key result
PA pressure-guided management reduces HF hospitalizations ~28% vs control in HFrEF.
- HR 0.72
- 95% CI 0.59-0.88
- P=0.0013
- n=550
Why the study?
Despite guideline-directed medical therapy, some HFrEF patients remain at high risk for hospitalization and mortality, prompting investigation into whether PA pressure-guided management improves outcomes based on tolerance of GDMT.
Does pulmonary artery pressure-guided heart failure management reduce heart failure hospitalization and mortality in patients with HFrEF?
Population
456 patients with HFrEF (LVEF <=40%)
Comparison
PA pressure-guided HF management vs control
Design
Pre-specified subgroup and post hoc analyses of a trial
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A post-hoc analysis of HFrEF patients in the CHAMPION trial showed the greatest benefit of PAP-guided therapy to decrease HFH and mortality in subjects who were taking both ACEI/ARB and beta blockers (hazard ratio 0.57 for HFH, 0.43 for mortality)”
JLJoAnn LindenfeldProfessor of medicine, Vanderbilt University Medical Center
“the benefit of hemodynamic-guided management was primarily due to a 28% reduction in heart failure hospitalizations, the same reduction previously shown in the CHAMPION trial”
“The present analysis confirms what was known from the CHAMPION trial, which created the evidence base for utilization of this technology: Hemodynamic monitoring reduces hospitalizations in all HF, regardless of EF.”
Implication
Pulmonary artery pressure-guided management significantly reduces heart failure hospitalizations in patients with HFrEF, with greater benefits observed in those receiving optimal guideline-directed medical therapy.
Key Points
- To assess the efficacy of remote pulmonary artery pressure-guided management on hospitalizations and mortality in patients with heart failure and reduced ejection fraction stratified by use of guideline-directed medical therapy.
- Conducted a pre-specified subgroup analysis of the randomized CHAMPION trial (NCT00531661) examining 456 patients with chronic heart failure and reduced ejection fraction (left ventricular ejection fraction ≤40%) out of 550 total enrolled participants.
- Evaluated heart failure hospitalizations and all-cause mortality using Andersen-Gill and Cox proportional hazards regression models across subgroups defined by baseline guideline-directed medical therapy tolerance.
- In the total cohort of 456 patients with reduced ejection fraction, pressure-guided management reduced heart failure hospitalizations by 28% (HR: 0.72; 95% CI: 0.59 to 0.88; p=0.0013) with a trend toward reduced mortality (HR: 0.68; 95% CI: 0.45 to 1.02; p=0.06).
- Among patients taking at least one guideline-directed medication (n=445), the intervention reduced heart failure hospitalizations by 33% (HR: 0.67; 95% CI: 0.54 to 0.82; p=0.0002) and mortality by 47% (HR: 0.63; 95% CI: 0.41 to 0.96; p=0.0293).
- In patients receiving both guideline-directed medical therapy components (n=337), pressure guidance reduced heart failure hospitalizations by 43% (HR: 0.57; 95% CI: 0.45 to 0.74; p<0.0001) and mortality by 57% (HR: 0.43; 95% CI: 0.24 to 0.76; p=0.0026).
Study Design
Type
RCT (n=550)
Structured PICO
Does pulmonary artery pressure-guided heart failure management reduce heart failure hospitalization and mortality in patients with HFrEF?
P
Population
456 patients with heart failure and reduced ejection fraction (LVEF ≤40%) analyzed as a pre-specified subgroup from the 550-patient CHAMPION trial.
I
Intervention
Pulmonary artery (PA) pressure-guided heart failure management
C
Comparator
Control group
O
Outcome
Heart failure hospitalization and mortality rateshard clinical
Main Result
Hazard Ratio: 0.72 (95% CI 0.59–0.88)
p-value: p=0.0013
Pulmonary artery pressure-guided management significantly reduces heart failure hospitalizations in patients with HFrEF, with greater benefits observed in those receiving optimal guideline-directed medical therapy.
Cite This Study
Givertz et al. (2017) conducted an RCT in Heart failure with reduced ejection fraction (HFrEF) (n=550). Pulmonary artery pressure-guided heart failure management vs. Control group was evaluated on Heart failure hospitalization (HR 0.72, 95% CI 0.59-0.88, p=0.0013). In patients with HFrEF, pulmonary artery pressure-guided management reduced heart failure hospitalization rates by 28% compared to control (HR 0.72; 95% CI 0.59-0.88; p=0.0013).