Recent Advances in Remote Pulmonary Artery Pressure Monitoring for Patients with Chronic Heart Failure: Current Evidence and Future Perspectives

Abstract

Chronic heart failure (HF) is associated with high hospital admission rates and has an enormous burden on hospital resources worldwide. Ideally, detection of worsening HF in an early phase would allow physicians to intervene timely and proactively in order to prevent HF-related hospitalizations, a concept better known as remote hemodynamic monitoring. After years of research, remote monitoring of pulmonary artery pressures (PAP) has emerged as the most successful technique for ambulatory hemodynamic monitoring in HF patients to date. Currently, the CardioMEMS and Cordella HF systems have been tested for pulmonary artery pressure monitoring and the body of evidence has been growing rapidly over the past years. However, several ongoing studies are aiming to fill the gap in evidence that is still very clinically relevant, especially for the European setting. In this comprehensive review, we provide an overview of all available evidence for PAP monitoring as well as a detailed discussion of currently ongoing studies and future perspectives for this promising technique that is likely to impact HF care worldwide.

Keywords: CardioMEMS; Cordella; e-health; heart failure; hemodynamics; remote care; sensor; telemonitoring.

Figure 1

The CardioMEMS HF system pulmonary artery pressure sensor. Reprinted from ESC Heart Failure Volume 7, Issue 3, Cowie et al., Rationale and design of the CardioMEMS Post-Market Multinational Clinical Study: COAST, pages 865–872, Copyright 2020, with permission from Wiley [23].

Figure 2

Primary endpoint hazard ratio and confidence interval evaluated over time in GUIDE-HF. Solid line reflects hazard ratio for data through each timepoint, shaded region reflects 95% confidence interval for each timepoint. Reprinted from The Lancet Volume 398, Issue 10304, Lindenfeld et al., Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial, pages 991–1001, Copyright 2021, with permission from Elsevier [28].

Figure 3

Heart failure-related hospitalization reduction in COAST. HFH: Heart failure hospitalization (HFH) reduction. Reprinted from ESC Heart Failure Volume 9, Issue 1, Cowie et al., Real-world evidence in a national health service: results of the UK CardioMEMS HF System Post-Market Study, pages 48–56, Copyright 2022, with permission from Elsevier [36].

Figure 4

Cumulative incidence of heart failure readmissions during 180 days after discharge, stratified ac-cording to treatment (without or with CardioMEMS). Reprinted from ESC Heart Failure Volume 9, Issue 4, Kishino et al., Effect of pulmonary artery pressure-guided therapy on heart failure read-mission in a nationally representative cohort, pages 2511–2517, Copyright 2022, with permission from Elsevier [42].

Figure 5

The Cordella HF system pulmonary artery pressure sensor. Reprinted from European Journal of Heart Failure Volume 22, Issue 10, Mullens et al., Effect of pulmonary artery pressure-guided therapy on heart failure readmission in a nationally representative cohort, pages 1912–1919, Creative Commons CC BY license [52].

Figure 6

Summary of the results from the SIRONA study. Patient adherence, quality of life and New York Heart Association (NYHA) classification. (A) Patient adherence with daily Cordella Heart Failure System (CHFS) and Cordella Pulmonary Artery Pressure Sensor (CPAS) readings over the first 90 days following implantation. (B) Kansas City Cardiomyopathy Questionnaire (KCCQ) score at baseline and 90 days following implantation. (C) NYHA classification at baseline and 90 days following implantation. Reprinted from European Journal of Heart Failure Volume 22, Issue 10, Mullens et al., Digital health care solution for proactive heart failure management with the Cordella Heart Failure System: results of the SIRONA first-in-human study, pages 1912–1919, Creative Commons CC BY license [52].

Figure 7

Summary of the results of the SIRONA 2 study. (A) Cumulative hazard rate curve through 180 days for HF hospitalizations, HF treatments in a hospital day-care setting, or urgent outpatient clinic HF visits. (B) Cumulative hazard rate curve through 180 days for HF hospitalizations, HF treatments in a hospital day-care setting, or urgent outpatient clinic HF visits and death. (C) Baseline, 1, 3 month KCCQ Overall Summary Score. (D) Baseline, 3 month 6 MWT. (E) Baseline, 1, 3 month NYHA Classification. (F) Number of patients with mean pulmonary artery pressure (mPAP) ≤ 25 and mPAP > 25 mmHg at both baseline and 90 days. Reprinted from ESC Heart Failure Volume 9, Issue 5, Sharif et al., Safety and efficacy of a wireless pulmonary artery pressure sensor: primary endpoint results of the SIRONA 2 clinical trial, pages 2862–2872, Copyright 2022, with permission from Elsevier [21].

Figure 8

Total number of diuretic changes pre-implantation and post-implantation. Total number of diuretic changes pre-implantation and post-implantation. * p < 0.05. Reprinted from ESC Heart Failure Volume 9, Issue 6, Dauw et al., Ambulatory haemodynamic-guided management reduces heart failure hospitalizations in a multicentre European heart failure cohort, pages 3858–3867, Copyright 2022, with permission from Elsevier [53].