Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2024
Monitoring significantly reduced all-cause mortality and heart failure hospitalisations in a meta-analysis.
Implantable haemodynamic monitoring in patients with heart failure has been shown to decrease heart failure hospitalisation, but a mortality benefit has not been clearly established. Previous meta-analyses examining a potential mortality benefit have had important limitations, including use of aggregate data. This meta-analysis included individual patient level data from three similar randomised, controlled trials including 1350 patients with heart failure with reduced ejection fraction (HFrEF).
Trial participants had a previous heart failure hospitalisation or elevated natriuretic peptide level and were on stable and optimally titrated guideline directed medical therapy. All were randomised to haemodynamic monitoring via an implantable device or to standard of care. About one-quarter of participants were women, about one-quarter were Black, and more than half had New York Heart Association (NYHA) class III symptoms. The mean ejection fraction was 25%, the mean cardiac index was 2.1 and the mean pulmonary artery pressure was 30 mmHg.
During a median follow up of 12 months, participants whose management was guided by implantable haemodynamic monitoring data had significantly decreased all-cause mortality (hazard ratio [HR], 0.75) and significantly decreased heart failure hospitalisation (HR, 0.64).
Comment: Based on these pooled data, I will be more likely to discuss implantable haemodynamic monitoring with patients with HFrEF and NYHA class III symptoms. I will tell them that although the main benefit of this strategy is reduced risk for heart failure hospitalisation, there is also a small mortality benefit after about one year.
Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.
Lindenfeld J, et al. Implantable hemodynamic monitors improve survival in patients with heart failure and reduced ejection fraction. J Am Coll Cardiol 2024; 83: 682-694.
This summary is taken from the following Journal Watch title: Cardiology.