Remote monitoring of pulmonary artery pressure using an implantable sensor in patients with chronic heart failure (HF) improves quality of life and reduces HF hospitalizations. This finding from the MONITOR-HF trial was presented at the ESC Heart Failure Congress.
The CardioMEMS HF System (Abbott Laboratories) is a monitoring device that is implanted into the pulmonary artery to provide remote detection of changes in blood pressure, which can indicate worsening HF, and enable clinicians to pre-emptively adjust patient care. In the USA, use of CardioMEMS was shown to reduce HF hospitalizations by 33% in patients with NYHA class III HF in the CHAMPION trial, but results from the GUIDE-HF trial, which was conducted during the COVID-19 pandemic in patients with NYHA class II–IV HF, were inconclusive.
The MONITOR-HF trial was an investigator-initiated, open-label trial to test CardioMEMS in a European health-care system. A total of 348 patients from the Netherlands with NYHA class III HF and a hospitalization for HF in the past 12 months were randomly assigned to high-level contemporary standard of care with or without CardioMEMS-guided therapy. The median age of participants was 69 years, and the median left ventricular ejection fraction was 30%.
After 12 months of follow-up, the mean difference between groups in the Kansas City Cardiomyopathy Questionnaire overall summary score was 7.13 (95% CI 1.51–12.75, P = 0.013), indicating a substantial improvement in quality of life in the remote monitoring group. Furthermore, use of the CardioMEMS System was associated with a 44% reduction in the number of HF hospitalizations at the end of follow-up (mean 1.8 years). Patients in the CardioMEMS group had reductions from baseline in pulmonary artery pressure and the plasma level of N-terminal pro-B-type natriuretic peptide, predominantly because of up-titration or down-titration of diuretics. Freedom from device-related or systems-related complications and sensor failure was 97.7% and 98.8%, respectively.
“We anticipate that these results will help to obtain reimbursement in the Netherlands and enhance uptake of the device in other European countries, especially considering the additive effect of haemodynamic monitoring on top of standard care,” say trial investigators Jasper Brugts and Rudolf de Boer. Patient selection, algorithms for integration into care pathways, and the use of artificial intelligence to support analysis and interpretation are ongoing considerations.
Brugts, J. J. et al. Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial. Lancet https://doi.org/10.1016/S0140-6736(23)00923-6 (2023)
Yacoub, M. H. & McLeod, C. The expanding role of implantable devices to monitor heart failure and pulmonary hypertension. Nat. Rev. Cardiol. 15, 770–779 (2018)
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Lim, G.B. Implantable haemodynamic sensor to remotely MONITOR HF. Nat Rev Cardiol 20, 514 (2023). https://doi.org/10.1038/s41569-023-00896-w