NEW YORK (Reuters Health) – Pulmonary artery (PA) pressure monitoring reduced hospitalizations of obese patients with heart failure, regardless of ejection fraction (EF), in a post-hoc analysis of the CardioMEMS Post Approval Study.
“I personally expected more obese patients to have a greater benefit,” Dr. D. Marshall Brinkley of Vanderbilt University Medical Center in Nashville told Reuters Health by email. “There was indeed a trend toward fewer hospitalizations as body mass index increased, but this was not highly statistically significant.”
“Patients with a BMI > 35 had to have a chest circumference of less than 65 inches to be included in the study, so it not known how well the sensor would work in patients with larger chests,” he noted. “Regardless of obesity, PA pressure monitoring requires that patients regularly send pressure transmissions and make medication changes as recommended by their heart failure treatment team. Patients who have difficulty with this might not realize a benefit.”
As reported in JACC: Heart Failure, Dr. Brinkley and colleagues analyzed data from the CardioMEMS Post Approval Study, a multicenter, open-label trial in 1,200 patients with New York Heart Association functional class III HF and previous HF hospitalization (HFH) within 12 months.
The analysis stratified patients according to EF <40% or 40% and greater, and by BMI <35 kg/m2 or 35 kg/m2 or greater.
Baseline PA diastolic pressure was higher in patients with BMI 35 kg/m2 or greater regardless of EF, but all PA pressures were reduced at 12 months in all cohorts.
The HFH rate was reduced by >50% in both cohorts for EF <40%: hazard ratio, 0.48 for BMI <35 kg/m2 and 0.40 for 35 kg/m2 or greater; and for EF 40% or greater: HR, 0.42 for BMI <35 kg/m2 and 0.34 for BMI 35 kg/m2 or greater.
There was a nonsignificant trend toward greater reduction with more obesity.
Further, the all-cause hospitalization rate was also significantly reduced during monitoring.
Summing up, the authors state, “Management guided by PA pressure monitoring effectively reduced pressures, HFH, and all-cause hospitalization in patients with obesity regardless of EF.”
Dr. Andrija Vidic, a cardiologist at the University of Kansas Medical Center in Kansas City commented in an email to Reuters Health, “The findings of the study are not surprising but should be interpreted with caution, as obese patients tend to have many other comorbidities, including diabetes with chronic kidney disease and obstructive sleep apnea, which are associated with excessive pressures. Elevated pressures can potentially be attributed to such comorbidities.”
“Unfortunately, in clinical practice, patients with multiple comorbidities do not appear to benefit as much from remote pressure monitoring,” he said. “Excessive diuretic use to lower pressures has been known to lead to significant renal failure and poor long-term outcomes, which were not reported in this observational study.”
“In addition,” he said, “relying on pressure monitors and minimizing the clinical acumen of providers can lead down the wrong path, as providers are solely treating numbers instead of patients’ underlying conditions.”
“A well selected group of patients would benefit from such innovation, but it should not be used across the board for all obese patients with heart failure, as with other well proven medical therapies,” he concluded.
Data analysis and funding for the CardioMEMS Post-Approval Study were provided by Abbott. Three coauthors are employees and three have received fees from the company.
SOURCE: https://bit.ly/3AmRMrE JACC Heart Failure, online September 8, 2021.
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