Pulmonary Artery Pressure–Guided Heart Failure Management Reduces 30-Day Readmissions
This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients. The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class II...
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| Published in | Circulation. Heart failure Vol. 9; no. 6 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
01.06.2016
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| Subjects | |
| Online Access | Get full text |
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| Abstract | This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.
The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080).
Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions.
http://www.clinicaltrials.gov. Unique identifier: NCT00531661. |
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| AbstractList | This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.BACKGROUNDThis study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080).METHODS AND RESULTSThe CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080).Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions.CONCLUSIONSPulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions.http://www.clinicaltrials.gov. Unique identifier: NCT00531661.CLINICAL TRIAL REGISTRATIONhttp://www.clinicaltrials.gov. Unique identifier: NCT00531661. This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients. The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080). Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions. http://www.clinicaltrials.gov. Unique identifier: NCT00531661. |
| Author | Stevenson, Lynne Warner Lindenfeld, JoAnn Desai, Akshay S. Adamson, Philip B. Abraham, William T. Bourge, Robert C. Bauman, Jordan |
| Author_xml | – sequence: 1 givenname: Philip B. surname: Adamson fullname: Adamson, Philip B. organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 2 givenname: William T. surname: Abraham fullname: Abraham, William T. organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 3 givenname: Lynne Warner surname: Stevenson fullname: Stevenson, Lynne Warner organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 4 givenname: Akshay S. surname: Desai fullname: Desai, Akshay S. organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 5 givenname: JoAnn surname: Lindenfeld fullname: Lindenfeld, JoAnn organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 6 givenname: Robert C. surname: Bourge fullname: Bourge, Robert C. organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) – sequence: 7 givenname: Jordan surname: Bauman fullname: Bauman, Jordan organization: From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women’s Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27220593$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/j.cardfail.2012.04.012 10.1056/NEJMoa1010029 10.1001/archinte.168.13.1371 10.1161/CIRCHEARTFAILURE.109.923300 10.1214/aos/1176345976 10.1016/j.jacc.2005.01.050 10.1016/j.jacc.2013.05.019 10.1161/CIRCULATIONAHA.108.783910 10.1016/j.jchf.2015.11.011 10.1161/CIRCHEARTFAILURE.113.001229 10.1161/HHF.0b013e318291329a 10.1161/CIRCULATIONAHA.111.018473 10.1016/j.jacc.2012.12.038 10.1016/S0140-6736(11)60101-3 10.1016/j.cardfail.2011.01.011 10.1001/jama.2012.216476 10.1016/S0002-9343(03)00132-3 10.1016/S0140-6736(15)00723-0 10.1016/j.jacc.2013.11.053 10.1016/j.ahj.2007.10.011 10.1161/CIR.0000000000000152 10.1016/j.ejheart.2008.01.007 10.1016/j.amjmed.2006.09.011 10.1161/CIRCOUTCOMES.108.802686 |
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| Snippet | This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.
The... This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients.BACKGROUNDThis... |
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| SubjectTerms | Aged Aged, 80 and over Arterial Pressure - drug effects Blood Pressure Monitoring, Ambulatory - instrumentation Cardiovascular Agents - therapeutic use Drug Substitution Female Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - physiopathology Humans Male Medicare Patient Readmission Predictive Value of Tests Pulmonary Artery - drug effects Pulmonary Artery - physiopathology Randomized Controlled Trials as Topic Retrospective Studies Risk Factors Telemetry - instrumentation Time Factors Transducers, Pressure Treatment Outcome United States Wireless Technology |
| Title | Pulmonary Artery Pressure–Guided Heart Failure Management Reduces 30-Day Readmissions |
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