Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure: a meta-analysis of three randomized controlled trials

Pascal R.D. Clephas, Sumant P. Radhoe, Eric Boersma, John Gregson, Pardeep S. Jhund, William T. Abraham, John J.V. McMurray, Rudolf A. de Boer, Jasper J. Brugts*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)
18 Downloads (Pure)

Abstract

Aims Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question. Methods A systematic literature search was performed for randomized clinical trials with PA pressure monitoring devices in patients and results with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Three eligible randomized clinical trials were identified that included 1898 outpatients in New York Heart Association functional classes II–IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. The mean followup was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58–0.86) (P = .0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61–0.91; P = .0037) and for all-cause mortality 0.92 (0.73–1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect. Conclusion The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations.

Original languageEnglish
Pages (from-to)3658-3668
Number of pages11
JournalEuropean Heart Journal
Volume44
Issue number37
DOIs
Publication statusPublished - 1 Oct 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Funding:
None to report for this meta-analysis. For the individual trials, the
CHAMPION and GUIDE HF trials were sponsored by Abbott
Laboratories (Illinois, USA). The MONITOR-HF trial was an investigator-initiated study sponsored by the Dutch ministry of health with the innovation
grant 2018 by the Health Care Institute for conditional reimbursement.
Abbott Laboratories (Illinois, USA) was obligated to extend the grant by
covering the clinical study costs with no part in the design, or conduct of
the study or any of its components, analyses and/or writing

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