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. 2019 Jun 1;4(6):556-563.
doi: 10.1001/jamacardio.2019.1384.

Association of Ambulatory Hemodynamic Monitoring of Heart Failure With Clinical Outcomes in a Concurrent Matched Cohort Analysis

Jacob Abraham  1 , Rupinder Bharmi  2 , Orvar Jonsson  3 , Guilherme H Oliveira  4 , Andre Artis  5 , Ali Valika  6 , Robert Capodilupo  7 , Philip B Adamson  2 , Gregory Roberts  2 , Nirav Dalal  2 , Akshay S Desai  8 , Raymond L Benza  9
Affiliations

Association of Ambulatory Hemodynamic Monitoring of Heart Failure With Clinical Outcomes in a Concurrent Matched Cohort Analysis

Jacob Abraham et al. JAMA Cardiol. .

Erratum in

Abstract

Importance: In a randomized clinical trial, heart failure (HF) hospitalizations were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care. It remains unclear if ambulatory monitoring could also improve long-term clinical outcomes in real-world practice.

Objective: To determine the association between ambulatory hemodynamic monitoring and rates of HF hospitalization at 12 months in clinical practice.

Design, setting, and participants: This matched cohort study of Medicare beneficiaries used claims data collected between June 1, 2014, and March 31, 2016. Medicare patients who received implants of a pulmonary artery pressure sensor were identified from the 100% Medicare claims database. Each patient who received an implant was matched to a control patient by demographic features, history of HF hospitalization, and number of all-cause hospitalizations. Propensity scoring based on comorbidities (arrhythmia, hypertension, diabetes, pulmonary disease, and renal disease) was used for additional matching. Data analysis was completed from July 2017 through January 2019.

Exposures: Implantable pulmonary artery pressure monitoring system.

Main outcomes and measures: The rates of HF hospitalization were compared using the Andersen-Gill method. Days lost owing to events were compared using a nonparametric bootstrap method.

Results: The study cohort consisted of 1087 patients who received an implantable pulmonary artery pressure sensors and 1087 matched control patients. The treatment and control cohorts were well matched by age (mean [SD], 72.7 [10.2] years vs 72.9 [10.1] years) and sex (381 of 1087 female patients [35.1%] in each group), medical history, comorbidities, and timing of preimplant HF hospitalization. At 12 months postimplant, 616 HF hospitalizations occurred in the treatment cohort compared with 784 HF hospitalizations in the control cohort. The rate of HF hospitalization was lower in the treatment cohort at 12 months postimplant (hazard ratio [HR], 0.76 [95% CI, 0.65-0.89]; P < .001). The percentage of days lost to HF hospitalizations or death were lower in the treatment group (HR, 0.73 [95% CI, 0.64-0.84]; P < .001) and the percentage of days lost owing to all-cause hospitalization or death were also lower (HR, 0.77 [95% CI, 0.68-0.88]; P < .001).

Conclusions and relevance: Patients with HF who were implanted with a pulmonary artery pressure sensor had lower rates of HF hospitalization than matched controls and spent more time alive out of hospital. Ambulatory hemodynamic monitoring may improve outcomes in patients with chronic HF.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Abraham reports receiving research grants and honoraria from Abbott and AbioMed. Dr Desai reports receiving honoraria from Abbott, Novartis, Relypsa, AstraZeneca, Boehringer-Ingelheim, Biofourmis, Signature Medical, Corvidia Therapeutics, Regeneron, Zogenix, and DalCor Pharma and research grants from Novartis. Dr Jonsson reported receiving honoraria from the Novartis and Abbott speakers’ bureaus. Dr Oliveira reported personal fees from Abbot Laboratories outside the submitted work. Dr Artis reported other from Methodist Hospitals during the conduct of the study and other from Abbott outside the submitted work. Dr Valika reported personal fees from Abbott Medical and personal fees from Novartis outside the submitted work. Dr Capodilupo reported personal fees from Abbott outside the submitted work. Dr Benza reported grants from Abbott during the conduct of the study and grants from the National Heart, Lung, and Blood Institute outside the submitted work. Drs Adamson, Dalal, Roberts, and Bharmi are salaried employees of Abbott. No other disclosures are reported.

Figures

Figure 1.
Figure 1.. Time Series of Heart Failure Hospitalizations in the 12 Months Before Pulmonary Artery Pressure Sensor Implant
Data from prior to the pulmonary artery pressure sensor implant include heart failure events (treatment cohort, 2532; control cohort, 2532; P > .99); length of stay per heart failure hospitalization (mean [SD]: treatment cohort, 5.5 [4.9] days; control cohort, 4.9 [4.1] days; P = .003); time in hospital per patient (mean [SD]: 12.7 [12.7] days; 11.4 [11.4] days; P = .05); and total hospital time (treatment cohort, 13 857 days; control cohort, 12 442 days; P > .99).
Figure 2.
Figure 2.. Cumulative Events After Pulmonary Artery Pressure (PAP) Sensor Implant
A, Heart failure (HF) hospitalizations. B, Deaths. C, Combined heart failure hospitalizations and death.
See this image and copyright information in PMC

References

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