Original Investigation
Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction

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Abstract

Background

Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes.

Objectives

CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT.

Methods

CHAMPION enrolled 550 patients with chronic HF regardless of left ventricular ejection fraction. A pre-specified sub-group analysis compared HF hospitalization and mortality rates between treatment and control groups in HFrEF patients (left ventricular ejection fraction ≤40%). Post hoc analyses in patients who tolerated GDMT were also performed. Hospitalizations and mortality were assessed using Andersen-Gill and Cox proportional hazards models.

Results

In 456 patients with HFrEF, HF hospitalization rates were 28% lower in the treatment group than in the control group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.88; p = 0.0013), with a strong trend for 32% lower mortality (HR: 0.68; 95% CI: 0.45 to 1.02; p = 0.06). A 445-patient subset received at least 1 GDMT (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or beta-blocker) at baseline; these patients had 33% lower HF hospitalization rates (HR: 0.67; 95% CI: 0.54 to 0.82; p = 0.0002) and 47% lower mortality (HR: 0.63; 95% CI: 0.41 to 0.96, p = 0.0293) than controls. Compared with controls, patients receiving both components of optimal GDMT (n = 337) had 43% lower HF hospitalizations (HR: 0.57; 95% CI: 0.45 to 0.74; p < 0.0001) and 57% lower mortality (HR: 0.43; 95% CI: 0.24 to 0.76; p = 0.0026).

Conclusions

PA pressure-guided HF management reduces morbidity and mortality in patients with HFrEF on GDMT, underscoring the important synergy of addressing hemodynamic and neurohormonal targets of HF therapy. (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients [CHAMPION]; NCT00531661)

Key Words

clinical outcomes
guideline-directed medical therapy
hemodynamic monitoring

Abbreviations and Acronyms

ACEI
angiotensin-converting enzyme inhibitor
ARB
angiotensin receptor blocker
CRT-D
cardiac resynchronization therapy with defibrillator
GDMT
guideline-directed medical therapy
HF
heart failure
HFrEF
heart failure with reduced ejection fraction
ICD
implantable cardioverter-defibrillator
LVEF
left ventricular ejection fraction
PA
pulmonary artery

Cited by (0)

Dr. Givertz has served on the scientific advisory board of St. Jude Medical. Dr. Stevenson has received research support from St. Jude Medical; and has served on the advisory boards of St. Jude Medical and Medtronic. Dr. Costanzo has been a member of the steering committee for the CardioMEMS HF System Post Approval Study; and has been a consultant to Abbott, St. Jude Medical, and Medtronic. Dr. Bourge has received study grant support and consulting payments from CardioMEMS (St. Jude Medical). Mr. Bauman is a former employee of St. Jude Medical, which is now Abbott. Mr. Ginn is a statistician employed by Abbott. Dr. Abraham has received consulting fees from CardioMEMS (St. Jude Medical) in roles as co-PI for the CHAMPION trial and a member of the steering committee for the CardioMEMS HF System Post Approval Study.

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