Implantable hemodynamic monitors reduce rates of mortality and heart failure (HF) hospitalizations when used to manage patients with HF and reduced ejection fraction (HFrEF), a pooled meta-analysis shows. These data were reported by JoAnn Lindenfeld, MD, of Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues, in a manuscript published Monday online and in the Feb. 13 issue of the Journal of the American College of Cardiology. Intracardiac and pulmonary artery pressures (PAPs) are often elevated in all types of cardiovascular disease and are associated with a greater risk of mortality. Several previous trials demonstrated that patients with HF can benefit from implantable hemodynamic monitors, such as by a reduction in HF hospitalizations. However, data on mortality in these studies are limited because there are little patient-level data, and follow-up durations have been short-term. The investigators in this study examined the relationship between implantable hemodynamic devices and mortality in patients who had HFrEF and confirm the findings about HF and rehospitalization rates from prior studies. Three randomized studies—GUIDE-HF (hemodynamic-guided management of heart failure), CHAMPION (cardioMEMS heart sensor allows monitoring of pressure to improve outcomes in NYHA class III heart failure patients) and LAPTOP-HF (left atrial pressure monitoring to optimize heart failure therapy)—were used to create a patient-level pooled meta-analysis. These studies all evaluated implantable hemodynamic monitors (two measured pulmonary artery pressures and one measured left atrial pressure). The primary endpoints of each of the three studies included a composite of HF hospitalizations, urgent HF visits and all-cause mortality at 12-months (GUIDE-HF), HF hospitalizations at 6-months (CHAMPION) and HF major acute cardiovascular and neurological events at overall follow-up (LAPTOP-HF). The pooled study included 1,350 patients (mean age=63.5 years, 25.3% female; 71.1% white, 24.7% Black) with HFrEF. Management with the implantable hemodynamic monitors significantly reduced overall mortality (hazard ratio [HR]=0.75, 95% confidence interval [CI]=0.57-0.99, p=0.043). Hospitalizations due to HF were also significantly reduced in this population (HR=0.64, 95% CI=0.55-0.76, p<0.0001). The authors concluded that that use of implantable hemodynamic monitoring devices reduces mortality and, confirming prior studies, reduces HF hospitalizations in patients with HFrEF. In an accompanying editorial, Marat Fudim, MD, MHS, of Duke University Medical Center, Durham, North Carolina; Javed Butler, MD, MPH, MBA, of Wroclaw Medical University, Wroclaw, Poland, and the Baylor Scott and White Research Institute, Dallas, and Veraprapas Kittipibul, MD, also of Duke University Medical Center, discussed implantable hemodynamic monitors and their potential in the management of HF and compared the three trials used in this present analysis. “The treatment effects of IHM in reducing mortality numerically surpass that of contemporary drug therapy trials and are encouraging; however, they must be viewed with some caveats,” the editorialists wrote. They discussed the disadvantages of the pooled analysis and recommended reconsideration of current implantable hemodynamic monitor guidelines. The editorialists concluded, “The real-world benefits of [implantable hemodynamic monitors] will likely improve with increasing experience as individual sites become more familiar with the technology and progressively refine algorithms that better align with specific patient populations, team members, and practice workflow.” Sources: Lindenfeld J, Costanzo MR, Zile MR, et al. Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2024;83:682-694. Fudim M, Butler J, Kittipibul V. Implantable Hemodynamic-GUIDE Monitors: A CHAMPION Among Devices for Heart Failure. J Am Coll Cardiol. 2024;83:695-698. Image Credit: irissca – stock.adobe.com