Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
ESC Heart Fail. 2022 Aug;9(4):2511-2517. doi: 10.1002/ehf2.13956. Epub 2022 May 13.
Pulmonary artery pressure (PAP)-guided therapy in patients with heart failure (HF) using the CardioMEMS (CMM) device, an implantable PAP sensor, has been shown to reduce HF hospitalizations in previous studies. We sought to evaluate the clinical benefit of the CMM device in regard to 30, 90, and 180 day readmission rates in real-world usage.
We queried the Nationwide Readmissions Database (NRD) to identify patients who underwent CMM implantation (International Classification of Diseases 9 and 10 codes) between the years 2014 and 2019 and studied their HF readmissions. Moreover, we compared CMM patients and their readmissions with a matched cohort of patients with HF but without CMM. Multivariable Cox regression analysis was performed to adjust for other predictors of readmissions. Prior to matching, we identified 5 326 530 weighted HF patients without CMM and 1842 patients with CMM. After propensity score matching for several patients and hospital-related characteristics, the cohort consisted of 1839 patients with CMM and 1924 with HF without CMM. Before matching, CMM patients were younger (67.0 ± 13.5 years vs. 72.3 ± 14.1 years, P < 0.001), more frequently male (62.7% vs. 51.5%, P < 0.001), with higher rates of prior percutaneous coronary intervention (16.9% vs. 13.2%, P = 0.002), peripheral vascular disease (29.6% vs. 17.8%, P < 0.001), pulmonary circulatory disorder (38.7% vs. 23.2%, P < 0.001), atrial fibrillation (51.2% vs. 45.3%, P = 0.002), prior left ventricular assist device (1.8% vs. 0.2%, P < 0.001), high income (32.2% vs. 16.4%, P < 0.001), and acute kidney disease (43.8% vs. 29.9%, P < 0.001). Readmission rates at 30 days were 17.3% vs. 20.9% for patients with vs. without CMM, respectively, and remained statistically significant after matching (17.3% vs. 21.5%, P = 0.002). The rates of 90 day (29.6% vs. 36.5%, P = 0.002) and 180 day (39.6% vs. 46.6%, P = 0.009) readmissions were lower in the CMM group. In a multivariable regression model, CMM was associated with lower risk of readmissions (hazard ratio 0.75, 95% confidence interval 0.63-0.89, P = 0.001).
The CMM device was associated with reduced HF rehospitalization rates in a nationally representative cohort of HF patients, validating the clinical trial that led to the approval of this device and its utilization in the treatment of HF.
使用可植入肺动脉压（PAP）传感器的 CardioMEMS（CMM）设备对心力衰竭（HF）患者进行 PAP 指导治疗，先前的研究表明这可降低 HF 住院率。我们旨在评估该设备在实际应用中 30、90 和 180 天再入院率方面的临床获益。
我们查询了全国再入院数据库（NRD），以确定 2014 年至 2019 年间接受 CMM 植入（国际疾病分类第 9 版和第 10 版代码）的患者，并研究他们的 HF 再入院情况。此外，我们比较了 CMM 患者及其再入院情况与无 CMM 的 HF 但具有匹配队列的患者。多变量 Cox 回归分析用于调整其他再入院预测因素。在匹配之前，我们确定了 5326530 名加权 HF 患者无 CMM 和 1842 名有 CMM 的患者。在对多个患者和医院相关特征进行倾向评分匹配后，该队列包括 1839 名 CMM 患者和 1924 名无 CMM 的 HF 患者。在匹配之前，CMM 患者年龄更小（67.0±13.5 岁 vs. 72.3±14.1 岁，P<0.001），更常为男性（62.7% vs. 51.5%，P<0.001），先前经皮冠状动脉介入治疗（16.9% vs. 13.2%，P=0.002）、外周血管疾病（29.6% vs. 17.8%，P<0.001）、肺循环疾病（38.7% vs. 23.2%，P<0.001）、心房颤动（51.2% vs. 45.3%，P=0.002）、先前左心室辅助装置（1.8% vs. 0.2%，P<0.001）、高收入（32.2% vs. 16.4%，P<0.001）和急性肾损伤（43.8% vs. 29.9%，P<0.001）的发生率更高。有和无 CMM 的患者在 30 天的再入院率分别为 17.3%和 20.9%，匹配后仍具有统计学意义（17.3% vs. 21.5%，P=0.002）。CMM 组的 90 天（29.6% vs. 36.5%，P=0.002）和 180 天（39.6% vs. 46.6%，P=0.009）再入院率较低。在多变量回归模型中，CMM 与再入院风险降低相关（风险比 0.75，95%置信区间 0.63-0.89，P=0.001）。
CMM 设备与 HF 患者的 HF 再住院率降低相关，验证了导致该设备批准及其在 HF 治疗中的应用的临床试验。
