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Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction.
Lindenfeld, JoAnn; Costanzo, Maria Rosa; Zile, Michael R; Ducharme, Anique; Troughton, Richard; Maisel, Alan; Mehra, Mandeep R; Paul, Sara; Sears, Samuel F; Smart, Frank; Johnson, Nessa; Henderson, John; Adamson, Philip B; Desai, Akshay S; Abraham, William T.
Afiliação
  • Lindenfeld J; Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: Joann.lindenfeld@vumc.org.
  • Costanzo MR; Midwest Cardiovascular Institute, Naperville, Illinois, USA.
  • Zile MR; Medical University of South Carolina, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Caroline, USA.
  • Ducharme A; Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
  • Troughton R; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
  • Maisel A; University of California San Diego, La Jolla, California, USA.
  • Mehra MR; Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Paul S; Catawba Valley Health System, Conover, North Carolina, USA.
  • Sears SF; East Carolina University, Greenville, North Carolina, USA.
  • Smart F; Louisiana State University School of Medicine, New Orleans, Louisiana, USA.
  • Johnson N; Abbott, Abbott Park, Illinois, USA.
  • Henderson J; Abbott, Abbott Park, Illinois, USA.
  • Adamson PB; Abbott, Abbott Park, Illinois, USA.
  • Desai AS; Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Abraham WT; Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
J Am Coll Cardiol ; 83(6): 682-694, 2024 02 13.
Article em En | MEDLINE | ID: mdl-38325994
ABSTRACT

BACKGROUND:

Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions.

OBJECTIVES:

The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies.

METHODS:

The patient-level pooled meta-analysis used 3 randomized studies (GUIDE-HF [Hemodynamic-Guided Management of Heart Failure], CHAMPION [CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients], and LAPTOP-HF [Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy]) of implantable hemodynamic monitors (2 measuring pulmonary artery pressures and 1 measuring left atrial pressure) to assess the effect on all-cause mortality and HF hospitalizations.

RESULTS:

A total of 1,350 patients with HFrEF were included. Hemodynamic-monitoring guided management significantly reduced overall mortality with an HR of 0.75 (95% CI 0.57-0.99); P = 0.043. HF hospitalizations were significantly reduced with an HR of 0.64 (95% CI 0.55-0.76); P < 0.0001.

CONCLUSIONS:

Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduces both mortality and HF hospitalizations. The reduction in HF hospitalizations is seen early in the first year of monitoring and mortality benefits occur after the first year.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Disfunção Ventricular Esquerda / Monitorização Hemodinâmica / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Diagnostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Disfunção Ventricular Esquerda / Monitorização Hemodinâmica / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Diagnostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 2024 Tipo de documento: Article