Key result
PA pressure sensor monitoring linked to ~45% lower HF hospitalizations vs pre-implantation.
Why the study?
The effectiveness of ambulatory hemodynamic monitoring in reducing heart failure hospitalizations outside of clinical trial settings was not established.
Does ambulatory hemodynamic monitoring via an implantable pulmonary artery pressure sensor reduce heart failure hospitalizations in real-world Medicare patients?
Cohort (n=1,114)
Yes
Does ambulatory hemodynamic monitoring via an implantable pulmonary artery pressure sensor reduce heart failure hospitalizations in real-world Medicare patients?
Hazard Ratio: 0.55 (95% CI 0.49–0.61)
Absolute Event Rate: 34.2% vs 91.6%
p-value: p=< 0.001
In a real-world cohort of U.S. Medicare patients, ambulatory hemodynamic monitoring via an implantable pulmonary artery pressure sensor significantly reduced heart failure hospitalizations and associated costs.
BACKGROUND: In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care. OBJECTIVES: This study examined the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of the clinical trial setting. METHODS: We conducted a retrospective cohort study using U.S. Medicare claims data from patients undergoing pulmonary artery pressure sensor implantation between June 1, 2014, and December 31, 2015. Rates of HFH during pre-defined periods before and after implantation were compared using the Andersen-Gill extension to the Cox proportional hazards model while accounting for the competing risk of death, ventricular assist device implantation, or cardiac transplantation. Comprehensive heart failure (HF)-related costs were compared over the same periods. RESULTS: Among 1,114 patients receiving implants, there were 1,020 HFHs in the 6 months before, compared with 381 HFHs, 139 deaths, and 17 ventricular assist device implantations and/or transplants in the 6 months after implantation (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.49 to 0.61; p < 0.001). This lower rate of HFH was associated with a 6-month comprehensive HF cost reduction of $7,433 per patient (IQR: $7,000 to $7,884), and was robust in analyses restricted to 6-month survivors. Similar reductions in HFH and costs were noted in the subset of 480 patients with complete data available for 12 months before and after implantation (HR: 0.66; 95% CI: 0.57 to 0.76; p < 0.001). CONCLUSIONS: As in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice is associated with lower HFH and comprehensive HF costs. These benefits are sustained to 1 year and support the "real-world" effectiveness of this approach to HF management.
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Desai et al. (2017) conducted a cohort in Heart Failure (n=1,114). Ambulatory hemodynamic monitoring (pulmonary artery pressure sensor) vs. 6-month pre-implantation period was evaluated on Heart failure hospitalization (HFH) (HR 0.55, 95% CI 0.49 to 0.61, p=< 0.001). Ambulatory hemodynamic monitoring via a pulmonary artery pressure sensor reduced heart failure hospitalizations compared to the 6-month pre-implantation period (HR 0.55; 95% CI 0.49-0.61; p<0.001).
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