PMID- 37286262 OWN - NLM STAT- MEDLINE DCOM- 20230609 LR - 20230613 IS - 2213-1787 (Electronic) IS - 2213-1779 (Linking) VI - 11 IP - 6 DP - 2023 Jun TI - Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides. PG - 691-698 LID - S2213-1779(23)00036-7 [pii] LID - 10.1016/j.jchf.2023.01.007 [doi] AB - BACKGROUND: In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs). OBJECTIVES: This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH. METHODS: In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models. RESULTS: Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58). CONCLUSIONS: Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813). CI - Copyright (c) 2023. Published by Elsevier Inc. FAU - Desai, Akshay S AU - Desai AS AD - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: https://twitter.com/akshaydesaimd. FAU - Maisel, Alan AU - Maisel A AD - University of California San Diego, La Jolla, California, USA. FAU - Mehra, Mandeep R AU - Mehra MR AD - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Zile, Michael R AU - Zile MR AD - Medical University of South Carolina, RJH Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA. FAU - Ducharme, Anique AU - Ducharme A AD - Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada. FAU - Paul, Sara AU - Paul S AD - Catawba Valley Health System, Conover, North Carolina, USA. FAU - Sears, Samuel F AU - Sears SF AD - East Carolina University, Greenville, North Carolina, USA. FAU - Smart, Frank AU - Smart F AD - Louisiana State University School of Medicine, New Orleans, Louisiana, USA. FAU - Bhatt, Kunjan AU - Bhatt K AD - Austin Heart Hospital, Austin, Texas, USA. FAU - Krim, Selim AU - Krim S AD - John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana, USA. FAU - Henderson, John AU - Henderson J AD - Abbott, Abbott Park, Illinois, USA. FAU - Johnson, Nessa AU - Johnson N AD - Abbott, Abbott Park, Illinois, USA. FAU - Adamson, Philip B AU - Adamson PB AD - Abbott, Abbott Park, Illinois, USA. FAU - Costanzo, Maria Rosa AU - Costanzo MR AD - Midwest Heart Specialists, Naperville, Illinois, USA. FAU - Lindenfeld, JoAnn AU - Lindenfeld J AD - Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA. CN - GUIDE-HF Investigators LA - eng SI - ClinicalTrials.gov/NCT03387813 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20230412 PL - United States TA - JACC Heart Fail JT - JACC. Heart failure JID - 101598241 RN - 0 (Natriuretic Peptides) SB - IM CIN - JACC Heart Fail. 2023 Jun;11(6):699-701. PMID: 37178082 MH - Humans MH - *Heart Failure MH - *COVID-19 MH - Hospitalization MH - Natriuretic Peptides MH - Hemodynamics OTO - NOTNLM OT - ambulatory hemodynamic monitoring OT - heart failure OT - heart failure hospitalization OT - natriuretic peptides OT - remote monitoring COIS- Funding Support and Author Disclosures The GUIDE-HF trial was funded by Abbott. Dr Desai has received institutional research grants from Abbott, Alnylam, AstraZeneca, Bayer, and Novartis; and is a consultant for Abbott, Alnylam, AstraZeneca, Axon Therapeutics, Avidity, Biofourmis, Boston Scientific, Cytokinetics, GlaxoSmithKline, Medpace, Merck, Novartis, Parexel, Regeneron, Roche, and Verily. Dr Maisel has been a consultant to Abbott. Dr Mehra is a consultant for Abbott, Natera, Paragonix, Moderna, Janssen, Broadview Ventures, Mesoblast, and Baim Institute for Clinical Research; has served on the Clinical Events Committee for GUIDE-HF through the Baim Institute for Clinical Research; and holds stock in NuPulseCV, Leviticus, and FineHeart. Dr Zile has been a consultant for Abbott. Dr Ducharme has been a consultant for Abbott. Dr Paul has been a consultant for Abbott. Dr Sears has received research grants from Medtronic and Zoll; is a consultant for Abbott, Medtronic, and Milestone Pharmaceutical; and has received personal fees from Medtronic and Zoll. Dr Smart has received research grants from Amgen; and is a consultant for Abbott. Mr Henderson is employed by Abbott. Dr Johnson is employed by Abbott. Dr Adamson is employed by Abbott. Dr Costanzo has been a consultant for Abbott. Dr Lindenfeld has received research grants from AstraZeneca, Sensible Medical, and Volumetrix; and is a consultant for Abbott, Alleviant Medical, AstraZeneca, Boehringer-Ingelheim, Boston Scientific, CVRx, Edwards Lifesciences, Impulse Dynamics, and V-Wave. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2023/06/08 01:08 MHDA- 2023/06/09 06:42 CRDT- 2023/06/07 21:00 PHST- 2022/08/24 00:00 [received] PHST- 2022/12/06 00:00 [revised] PHST- 2023/01/09 00:00 [accepted] PHST- 2023/06/09 06:42 [medline] PHST- 2023/06/08 01:08 [pubmed] PHST- 2023/06/07 21:00 [entrez] AID - S2213-1779(23)00036-7 [pii] AID - 10.1016/j.jchf.2023.01.007 [doi] PST - ppublish SO - JACC Heart Fail. 2023 Jun;11(6):691-698. doi: 10.1016/j.jchf.2023.01.007. Epub 2023 Apr 12.