Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States of America.
Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States of America.
Prog Cardiovasc Dis. 2021 Nov-Dec;69:47-53. doi: 10.1016/j.pcad.2021.11.011. Epub 2021 Nov 25.
Heart failure (HF) is associated with considerable morbidity and mortality. The increasing prevalence of HF and inpatient HF hospitalization has a considerable burden on healthcare cost and utilization. The recognition that hemodynamic changes in pulmonary artery pressure (PAP) and left atrial pressure precede the signs and symptoms of HF has led to interest in hemodynamic guided HF therapy as an approach to allow earlier intervention during a heart failure decompensation. Remote patient monitoring (RPM) utilizing telecommunication, cardiac implantable electronic device parameters and implantable hemodynamic monitors (IHM) have largely failed to demonstrate favorable outcomes in multicenter trials. However, one positive randomized clinical trial testing the CardioMEMS device (followed by Food and Drug Administration approval) has generated renewed interest in PAP monitoring in the HF population to decrease hospitalization and improve quality of life. The COVID-19 pandemic has also stirred a resurgence in the utilization of telehealth to which RPM using IHM may be complementary. The cost effectiveness of these monitors continues to be a matter of debate. Future iterations of devices aim to be smaller, less burdensome for the patient, less dependent on patient compliance, and less cumbersome for health care providers with the integration of artificial intelligence coupled with sophisticated data management and interpretation tools. Currently, use of IHM may be considered in advanced heart failure patients with the support of structured programs.
心力衰竭（HF）与相当高的发病率和死亡率相关。HF 的发病率不断上升，以及因 HF 住院的患者不断增加，给医疗保健成本和利用带来了相当大的负担。人们认识到肺动脉压（PAP）和左心房压的血流动力学变化先于 HF 的体征和症状，这导致人们对血流动力学指导的 HF 治疗产生了兴趣，这种方法可以在 HF 失代偿期间更早地进行干预。利用远程通信、心脏植入式电子设备参数和植入式血流动力学监测器（IHM）的远程患者监测（RPM）在多中心试验中基本上未能显示出有利的结果。然而，一项测试 CardioMEMS 设备的阳性随机临床试验（随后获得了食品和药物管理局的批准），重新激发了人们对 HF 人群中 PAP 监测的兴趣，以减少住院和改善生活质量。COVID-19 大流行也促使远程医疗的使用重新兴起，IHM 的 RPM 可能是其补充。这些监测器的成本效益仍然是一个有争议的问题。未来的设备迭代旨在更小、对患者的负担更小、对患者依从性的依赖性更小、对医疗保健提供者来说更方便，同时结合人工智能以及复杂的数据管理和解释工具。目前，在有结构化方案支持的情况下，可以考虑在晚期 HF 患者中使用 IHM。
