PMID- 28330751
OWN - NLM
STAT- MEDLINE
DCOM- 20170724
LR  - 20220409
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 69
IP  - 19
DP  - 2017 May 16
TI  - Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in 
      "Real-World" Clinical Practice.
PG  - 2357-2365
LID - S0735-1097(17)35978-8 [pii]
LID - 10.1016/j.jacc.2017.03.009 [doi]
AB  - BACKGROUND: In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of 
      Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional 
      Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) 
      rates were lower in patients managed with guidance from an implantable pulmonary 
      artery pressure sensor compared with usual care. OBJECTIVES: This study examined 
      the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of 
      the clinical trial setting. METHODS: We conducted a retrospective cohort study 
      using U.S. Medicare claims data from patients undergoing pulmonary artery 
      pressure sensor implantation between June 1, 2014, and December 31, 2015. Rates 
      of HFH during pre-defined periods before and after implantation were compared 
      using the Andersen-Gill extension to the Cox proportional hazards model while 
      accounting for the competing risk of death, ventricular assist device 
      implantation, or cardiac transplantation. Comprehensive heart failure 
      (HF)-related costs were compared over the same periods. RESULTS: Among 1,114 
      patients receiving implants, there were 1,020 HFHs in the 6 months before, 
      compared with 381 HFHs, 139 deaths, and 17 ventricular assist device 
      implantations and/or transplants in the 6 months after implantation (hazard ratio 
      [HR]: 0.55; 95% confidence interval [CI]: 0.49 to 0.61; p < 0.001). This lower 
      rate of HFH was associated with a 6-month comprehensive HF cost reduction of 
      $7,433 per patient (IQR: $7,000 to $7,884), and was robust in analyses restricted 
      to 6-month survivors. Similar reductions in HFH and costs were noted in the 
      subset of 480 patients with complete data available for 12 months before and 
      after implantation (HR: 0.66; 95% CI: 0.57 to 0.76; p < 0.001). CONCLUSIONS: As 
      in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice 
      is associated with lower HFH and comprehensive HF costs. These benefits are 
      sustained to 1 year and support the "real-world" effectiveness of this approach 
      to HF management.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Desai, Akshay S
AU  - Desai AS
AD  - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. 
      Electronic address: adesai@partners.org.
FAU - Bhimaraj, Arvind
AU  - Bhimaraj A
AD  - Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 
      Houston, Texas.
FAU - Bharmi, Rupinder
AU  - Bharmi R
AD  - Abbott, Sylmar, California.
FAU - Jermyn, Rita
AU  - Jermyn R
AD  - Cardiology Department, St. Francis Hospital, New York, New York.
FAU - Bhatt, Kunjan
AU  - Bhatt K
AD  - Austin Heart, Austin, Texas.
FAU - Shavelle, David
AU  - Shavelle D
AD  - Division of Cardiovascular Medicine, University of Southern California, Los 
      Angeles, California.
FAU - Redfield, Margaret M
AU  - Redfield MM
AD  - Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
FAU - Hull, Robert
AU  - Hull R
AD  - West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
FAU - Pelzel, Jamie
AU  - Pelzel J
AD  - Centracare Heart and Vascular Center, St. Cloud, Minnesota.
FAU - Davis, Kevin
AU  - Davis K
AD  - Abbott, Sylmar, California.
FAU - Dalal, Nirav
AU  - Dalal N
AD  - Abbott, Sylmar, California.
FAU - Adamson, Philip B
AU  - Adamson PB
AD  - Abbott, Sylmar, California.
FAU - Heywood, J Thomas
AU  - Heywood JT
AD  - Division of Cardiology, Scripps Clinic, La Jolla, California.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170319
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2017 May 16;69(19):2366-2368. PMID: 28330750
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Heart Failure/*prevention & control
MH  - Hemodynamics
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Monitoring, Ambulatory
MH  - Retrospective Studies
OTO - NOTNLM
OT  - CardioMEMS
OT  - clinical effectiveness
OT  - implantable hemodynamic monitor
EDAT- 2017/03/24 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/03/24 06:00
PHST- 2017/02/18 00:00 [received]
PHST- 2017/03/02 00:00 [revised]
PHST- 2017/03/03 00:00 [accepted]
PHST- 2017/03/24 06:00 [pubmed]
PHST- 2017/07/25 06:00 [medline]
PHST- 2017/03/24 06:00 [entrez]
AID - S0735-1097(17)35978-8 [pii]
AID - 10.1016/j.jacc.2017.03.009 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2017 May 16;69(19):2357-2365. doi: 10.1016/j.jacc.2017.03.009. 
      Epub 2017 Mar 19.