Key result
Implantable hemodynamic monitoring linked to ~57% fewer heart failure hospitalizations.
Why the study?
While hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure, little was known about the characteristics of long-term hemodynamic information or how it relates to meaningful clinical events.
Does clinical management guided by a permanent right ventricular implantable hemodynamic monitor reduce hospitalizations in patients with chronic heart failure?
Observational (n=32)
Does clinical management guided by a permanent right ventricular implantable hemodynamic monitor reduce hospitalizations in patients with chronic heart failure?
Answers are grounded in this paper and cite their sources.
Long-term ambulatory right ventricular pressure monitoring via an implantable device detects pressure increases days before volume-overload hospitalizations and is associated with a 57% reduction in heart failure hospitalization rates when used to guide clinical management.
Objectives This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients. Background Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events. Methods Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients' historical controls. Results Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 +/- 4% (p < 0.05) and heart rate increased by 11 +/- 2% (p < 0.05). Pressure increases occurred in 9 of 12 events 4 +/- 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p < 0.01) after hemodynamic data were used. Conclusions Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.
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Adamson et al. (2003) conducted an observational in Chronic heart failure (n=32). Implantable hemodynamic monitor (IHM)-guided clinical management vs. Historical control (9 months prior to using IHM data for clinical decision-making) was evaluated on Hospitalizations per patient-year (57% reduction, p=<0.01). Using implantable hemodynamic monitor data for clinical management reduced heart failure hospitalizations by 57%, from 1.08 to 0.47 per patient-year.
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