Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: https://twitter.com/akshaydesaimd.
University of California San Diego, La Jolla, California, USA.
JACC Heart Fail. 2023 Jun;11(6):691-698. doi: 10.1016/j.jchf.2023.01.007. Epub 2023 Apr 12.
In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs).
This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH.
In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models.
Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58).
Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813).
在有症状心力衰竭（HF）和既往心力衰竭住院（HFH）的患者中，使用无线肺动脉压（PAP）传感器进行血流动力学指导的 HF 管理可减少 HFH，但尚不清楚这些益处是否扩展到最近未住院但因利钠肽（NPs）升高而仍有风险的患者。
本研究评估了血流动力学指导的 HF 管理在有升高的 NPs 但无近期 HFH 的患者中的疗效和安全性。
在 GUIDE-HF（心力衰竭的血流动力学指导管理）试验中，1000 名纽约心脏协会（NYHA）心功能 II 至 IV 级 HF 且既往有 HFH 或升高的 NP 水平的患者被随机分配至血流动力学指导的 HF 管理或常规护理。作者根据治疗分配和入组分层（HFH 与升高的 NPs），使用 Cox 比例风险模型评估了 12 个月时全因死亡率和总 HF 事件的主要研究复合终点。
在 999 名可评估患者中，557 名患者根据既往 HFH 入组，442 名患者根据单独升高的 NPs 入组。根据 NP 标准入组的患者年龄更大，更常见为白人，体重指数较低，NYHA 分级较低，糖尿病较少，心房颤动较多，基线 PAP 较低。NP 组的患者在全随访期间（100 患者年 40.9 例 vs 100 患者年 82.0 例）和 COVID-19 前分析（100 患者年 43.6 例 vs 100 患者年 88.0 例）的事件发生率均较低。在整个研究期间（交互 P = 0.71）和 COVID-19 前分析（交互 P = 0.58），血流动力学监测对主要终点的影响在入组分层中是一致的。
GUIDE-HF 中的入组分层结果一致表明，在有慢性 HF 和升高的 NPs 但无近期 HFH 的扩展患者群体中，考虑进行血流动力学监测是合理的。（心力衰竭的血流动力学指导管理 [GUIDE-HF]；NCT03387813）。
