May 2024
Implantable haemodynamic monitors for heart failure with reduced ejection fraction

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.

J Am Coll Cardiol