HealthDay News –   Ambulatory pulmonary artery (PA) pressure-guided management of heart failure patients is more effective in reducing heart failure hospitalizations than management of patient clinical signs/symptoms alone, according to a study published online Feb. 10 in JACC: Heart Failure.

Maria R. Costanzo, MD, from the Advocate Heart Institute in Naperville, Ill., and colleagues randomized 550 New York Association functional class III heart failure patients (with a heart failure hospitalization in the prior year) to active monitoring (PA pressure-guided heart failure management plus standard of care) or to the blind therapy group (heart failure management by standard clinical assessment).Participants were followed for a minimum of six months.

The researchers found that patients receiving active monitoring had a higher frequency of medication adjustments. Targeted dose adjustments were possible in these patients, with the administration of higher doses of diuretics and vasodilators. Of note, in patients in the active monitoring group, renal function was preserved despite increases in diuretic doses.


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They found that incorporation of a PA pressure-guided treatment algorithm was more effective in reducing HF hospitalizations than management of patient clinical signs or symptoms alone. 

“Incorporation of a PA pressure-guided treatment algorithm to decrease filling pressures led to targeted changes, particularly in diuretics and vasodilators, and was more effective in reducing heart failure hospitalizations than management of patient clinical signs/symptoms alone,” the authors write.

Several authors disclosed financial ties to the medical device industry.


Summary and Clinical Applicability

The use of implantable hemodynamic monitoring devices in ambulatory patients has shown that cardiac filling pressures rise weeks before the onset of signs and symptoms of decompensated heart failure.2 In this study, elevated cardiac filling pressures, which increase the risk of hospitalizations and mortality, can be detected using an ambulatory PA pressure monitoring system before onset of symptomatic congestion.1 This detection can result in earlier interventions to prevent heart failure hospitalizations.  Once validated, algorithms may later be developed that identify specific pulmonary artery target pressure ranges for patients with heart failure, that result in clinically significant reductions in hospitalizations resulting from heart failure. 

Reference

1. Costanzo MR, Stevenson LW, Adamson PB, et al. Interventions Linked to Decreased Heart Failure Hospitalizations During Ambulatory Pulmonary Artery Pressure Monitoring. JACC Heart Fail. (2016): n. pag. Web. 19 Feb. 2016.

2. Merchant FM, Dec GW, Singh JP. Implantable sensors for heart failure. Circ Arrhythm Electrophysiol. 2010;3(6):657-67.