By Dr Jonathan Shurlock
Edited by Dr Saadia Aslam
Remote monitoring of patients with heart failure (HF), via pulmonary artery pressure monitoring, is included in the ESC HF guidelines. Previous studies (CHAMPION and GUIDE-HF) of pulmonary artery pressure monitoring have resulted in equipoise, with this device receiving a class IIb recommendation by the ESC.
MONITOR-HF was an open label, multi-centre, randomised control trial, across 25 centres in the Netherlands. Patients with chronic HF, NYHA class III symptoms and at least one previous HF hospitalisation were eligible. Participants were randomised (1:1) to usual standard care or haemodynamic monitoring over a mean follow up period of 18 months. Changes in the score of Kansa City Cardiomyopathy Questionnaire (KCCQ) from baseline to 12 months, as a marker of self-perceived disease severity and burden, was the primary outcome measure. Where scores represent health status as follows: 0 to 24: very poor to poor; 25 to 49: poor to fair; 50 to 74: fair to good; and 75 to 100: good to excellent. Secondary outcome measures included HF hospitalisations.
348 participants were randomised (median age: 69 years (IQR 61–75) with a median ejection fraction of 30% (IQR: 23–40). There was a significant improvement of 7.1 points in the KCCQ score at 12 months, in favour of the group undergoing haemodynamic monitoring (p=0.013). At approximately 2 years there was a 44% reduction (HR 0.56; 95% CI 0.38–0.84; p<0.01) in HF hospitalisations or urgent outpatient visits in the haemodynamic monitoring group in comparison to standard care (117 vs 212, respectively).
Device or system complication rates had a reported incidence of 2.3%, including 2 episodes of haemoptysis, and 2 episodes of arrhythmia. There was a 1.2% rate of sensor failure during the follow up period.
Interviewed by the ESC press office, the study’s lead author Dr. Jasper Brugts commented: “Pulmonary artery pressure monitoring showed a substantial and significant effect on quality of life and heart failure hospitalisations […], an efficient method with a low time requirement.” See further details of this interview here.
The full study can be found here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00923-6/fulltext
