Adamson Philip B, Abraham William T, Stevenson Lynne Warner, Desai Akshay S, Lindenfeld JoAnn, Bourge Robert C, Bauman Jordan
From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.).
Circ Heart Fail. 2016 Jun;9(6). doi: 10.1161/CIRCHEARTFAILURE.115.002600.
This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.
The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080).
Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions.
http://www.clinicaltrials.gov. Unique identifier: NCT00531661.
本研究探讨肺动脉压力引导下的心力衰竭（HF）护理对符合医疗保险条件患者30天再入院率的影响。
心脏微机电系统（CardioMEMS）心脏传感器用于改善纽约心脏协会III级心力衰竭患者结局的监测压力（CHAMPION）试验纳入了550例在肺动脉植入永久性基于MEMS的压力传感器的患者。受试者被随机分为治疗组（研究者可获取上传的压力数据）或对照组（研究者无法获取上传的压力数据）。本分析聚焦于245例符合医疗保险条件的受试者，其每日传输数据的依从率为93%，而总体人群的依从率为88%。与仅使用症状和每日体重的对照组相比，治疗组利用压力信息更频繁地调整药物治疗。在植入后的515天随访期间，治疗组的心力衰竭住院总发生率比对照组低49%（60次心力衰竭住院，0.34次事件/患者年），对照组为117次心力衰竭住院，0.67次事件/患者年；风险比为0.51，95%置信区间为0.37 - 0.70；P<0.0001）。在177次心力衰竭住院中，155次符合首次心力衰竭住院标准。治疗组的全因30天再入院率比对照组低58%（0.07次事件/患者年），对照组为0.18次事件/患者年（风险比0.42，95%置信区间为0.22 - 0.80；P = 0.0080）。
对符合医疗保险条件的患者进行肺动脉压力引导的心力衰竭管理可使心力衰竭住院总数减少49%，全因30天再入院率减少58%。
