Long-Term Adherence and Outcomes in Ambulatory Heart Failure Patients Using the Cordella Pulmonary Artery Sensor System

BACKGROUND: Heart failure (HF) patient adherence and clinician response times are central to the effectiveness of hemodynamic-guided management using implantable pulmonary artery sensors. We analyzed the relationship of both with clinical outcomes through 2 years in the PROACTIVE-HF study. METHODS AND RESULTS: To determine if patient adherence and clinician response times were linked to clinical outcomes, we calculated the incidence of heart failure events (HFEs), including HF hospitalizations (HFH), in patients with adherence above or below the median and in clinician response time above or below the median, over 2 years using Poisson regression. Over 2 years of follow-up in the PROACTIVE-HF trial (N=456), patients transmitted data a median of 6.3 days per week and clinicians responded within a median of 1.7 days. Low-adherence patients had more HFH than high-adherence patients (0.71[CI:0.6-0.83] vs 0.55 [CI:0.46-0.66], p=0.04). This association was attenuated and no longer significant after adjustment for baseline differences between groups (adjusted IRR 0.83; 95% CI 0.64-1.09; P=0.19). Low clinician compliance was associated with more HFH than high clinician compliance (0.72 [CI: 0.61-0.84] vs 0.54 [CI: 0.45-0.65], p=0.02). CONCLUSIONS: In this 2-year analysis from the PROACTIVE-HF trial, both lower patient adherence and lower clinician response times were associated with more HFHs, although these findings were attenuated when adjusting for baseline differences. These findings reinforce that patient engagement with their clinical data along with responsive clinicians is fundamental to the success of remote HF management.