Heart Failure and Respiratory Hospitalizations Are Reduced in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease With the Use of an Implantable Pulmonary Artery Pressure Monitoring Device

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). Elevated pulmonary arterial (PA) pressure can be seen in both conditions and has been shown to predict morbidity and mortality. Methods and Results A total of 550 subjects with New York Heart Association functional class III HF were randomly assigned to the treatment (n = 270) and control (n = 280) groups in the CHAMPION Trial. Physicians had access to the PA pressure measurements in the treatment group only, in which HF therapy was used to lower the elevated pressures. HF and respiratory hospitalizations were compared in both groups. A total of 187 subjects met criteria for classification into the COPD subgroup. In the entire cohort, the treatment group had a 37% reduction in HF hospitalization rates (P < .0001) and a 49% reduction in respiratory hospitalization rates (P = .0061). In the COPD subgroup, the treatment group had a 41% reduction in HF hospitalization rates (P = .0009) and a 62% reduction in respiratory hospitalization rates (P = .0023). The rate of respiratory hospitalizations in subjects without COPD was not statistically different (P = .76). Conclusions HF management incorporating hemodynamic information from an implantable PA pressure monitor significantly reduces HF and respiratory hospitalizations in HF subjects with comorbid COPD compared with standard care.

The prognostic significance of lung function in stable heart failure outpatients

“…Accurate risk stratification is important, as it can help guide therapeutic decision‐making, and clinicians should routinely assess patient prognosis in the course of standard evaluation of HF. A recognition of a concomitant COPD in HF patients is important because these patients have lower exercise performance, increased rates of preventable hospitalizations, and increased risk of obstructive sleep apnea, and they may have extra benefit of a more vigilant monitoring program . An RSP was highly prevalent in this cohort of HF patients; the high prevalence of RSP implicates that COPD therapy should not be instituted before a spirometry is performed.…”

The Future of Heart Failure Diagnosis, Therapy, and Management

“…The strategy to monitor and reduce ambulatory pulmonary artery filling pressures has been shown to decrease pulmonary and HF admissions, as well, which may reflect either the sensitivity of airway function to fluid or the overlap of pulmonary and cardiac dyspnea. 107 The combination of HF and intrinsic kidney disease presents very different challenges with and without dialysis, but both operate within a narrow window for optimal volume and blood pressure, and are associated with high prevalence of other vascular disease.…”

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

“…These long‐term benefits were seen in patients with HF and preserved EF,32 secondary pulmonary hypertension,33 and co‐morbid chronic obstructive CAD 34. Hospitalization reductions were seen after an average of 18 months of randomized follow‐up, with additional long‐term benefits noted in the 13 months of ‘open‐access’, which immediately followed the end of the randomized follow‐up in the trial 35.…”