Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
J Am Coll Cardiol. 2017 May 16;69(19):2357-2365. doi: 10.1016/j.jacc.2017.03.009. Epub 2017 Mar 19.
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.
This study examined the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of the clinical trial setting.
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.
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).
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.
在 CHAMPION（CardioMEMS 心脏传感器可监测肺动脉压以改善纽约心脏协会 [NYHA] 心功能 III 级心力衰竭患者的预后）试验中，与常规护理相比，接受植入式肺动脉压力传感器指导管理的心力衰竭患者的心力衰竭住院（HFH）率更低。
本研究旨在检验在临床试验以外环境下使用动态血流动力学监测减少 HFH 的效果。
我们采用回顾性队列研究方法，利用美国 2014 年 6 月 1 日至 2015 年 12 月 31 日期间接受肺动脉压力传感器植入术患者的医疗保险索赔数据。采用 Andersen-Gill 扩展 Cox 比例风险模型比较植入前后预先设定时间段内的 HFH 发生率，同时考虑死亡、心室辅助装置植入或心脏移植的竞争风险。同期比较综合心力衰竭（HF）相关费用。
在 1114 例接受植入术的患者中，植入前 6 个月有 1020 例 HFH，而植入后 6 个月有 381 例 HFH、139 例死亡、17 例心室辅助装置植入和/或移植（风险比 [HR]：0.55；95%置信区间 [CI]：0.49 至 0.61；p < 0.001）。较低的 HFH 发生率与每位患者 6 个月综合 HF 成本降低 7433 美元（IQR：7000 美元至 7884 美元）相关，在仅纳入 6 个月幸存者的分析中结果稳健。在植入前后 12 个月有完整数据的 480 例患者亚组中，也观察到 HFH 和成本的类似降低（HR：0.66；95%CI：0.57 至 0.76；p < 0.001）。
与临床试验一样，在临床实践中使用动态血流动力学监测与较低的 HFH 和综合 HF 成本相关。这些益处可持续至 1 年，支持该 HF 管理方法的“真实世界”有效性。
