Key result
PA pressure-guided HF management linked to ~50% fewer hospitalizations across all eGFR quartiles.
Why the study?
It remains unstudied if hemodynamic-guided heart failure management is effective across severities of comorbid renal insufficiency or impacts renal function over time.
Does hemodynamic-guided heart failure management using pulmonary artery sensors reduce heart failure hospitalizations in patients with NYHA class III symptoms across different severities of chronic kidney disease?
Cohort (n=1,200)
Yes
Does hemodynamic-guided heart failure management using pulmonary artery sensors reduce heart failure hospitalizations in patients with NYHA class III symptoms across different severities of chronic kidney disease?
Answers are grounded in this paper and cite their sources.
Hemodynamic-guided heart failure management using pulmonary artery sensors significantly reduces heart failure hospitalizations across all stages of chronic kidney disease while generally preserving renal function.
Background: Hemodynamic-guided heart failure management is a superior strategy to prevent decompensation leading to hospitalization compared with traditional clinical methods. It remains unstudied if hemodynamic-guided care is effective across severities of comorbid renal insufficiency or if this strategy impacts renal function over time. Methods: In the CardioMEMS US PAS (Post-Approval Study), heart failure hospitalizations were compared from 1 year before and after pulmonary artery sensor implantation in 1200 patients with New York Heart Association class III symptoms and a previous hospitalization. Hospitalization rates were evaluated in all patients grouped into baseline estimated glomerular filtration rate (eGFR) quartiles. Chronic kidney disease progression was evaluated in patients with renal function follow-up data (n=911). Results: Patients with stage 2 or greater chronic kidney disease at baseline exceeded 80%. Heart failure hospitalization risk was lower in all eGFR quartiles ranging from a hazard ratio of 0.35 (0.27–0.46; P <0.0001) in patients with eGFR >65 mL/min per 1.73 m 2 to 0.53 (0.45–0.62; P <0.0001) in patients with eGFR ≤37 mL/min per 1.73 m 2 . Renal function was preserved or improved in most patients. Survival was different between quartiles and lower in quartiles with more advanced chronic kidney disease. Conclusions: Hemodynamic-guided heart failure management using remotely obtained pulmonary artery pressures is associated with lower hospitalization rates and general preservation of renal function in all eGFR quartiles or chronic kidney disease stages.
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RAVAL et al. (2023) conducted a cohort in Heart failure (n=1,200). Hemodynamic-guided heart failure management (pulmonary artery sensor) vs. 1 year prior to implantation (historical self-control) was evaluated on Heart failure hospitalizations (HR 0.35 to 0.53, 95% CI 0.27-0.46 to 0.45-0.62, p=<0.0001). Hemodynamic-guided heart failure management using pulmonary artery sensors was associated with lower hospitalization risk across all eGFR quartiles (HRs ranging from 0.35 to 0.53; P<0.0001).
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