Management of the Patient with Heart Failure and an Implantable Pulmonary Artery Hemodynamic Sensor

Abstract

Purpose of Review Heart failure (HF) management guided by hemodynamics obtained from an implantable pulmonary artery pressure (PAP) sensor (CardioMEMS) improves symptoms and reduces HF hospitalizations (HFH). This paper reviews the theoretical basis of pulmonary vascular physiology, summarizes recently published data about CardioMEMS, and provides practical guidelines for patient selection and management. Recent Findings Compared to patients managed by standard care, HF patients randomized to PAP-guided treatment have a higher frequency of medication adjustments, resulting in lower PAP and fewer HFH. Real-world analyses further support associations between implant of the CardioMEMS sensor with reductions in PAP, hospitalizations, and mortality. Summary Implantable, wireless hemodynamic sensor technology is a promising remote monitoring platform for chronic HF. A phased approach using a treatment algorithm may improve the efficiency and effectiveness of pressure-guided therapy.

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

“…The CardioMEMS™ (CardioMEMS HF System, Abbott, Sylmar, CA) is an implantable wireless sensor placed in the left lower lobe pulmonary artery (through a catheter-delivery system), capable of remotely measuring PAP [18]. It is the only invasive HF remote monitoring sensor with Food and Drug Administration (FDA) approval and European Conformity (CE) mark [19].…”

“…It is the only invasive HF remote monitoring sensor with Food and Drug Administration (FDA) approval and European Conformity (CE) mark [19]. Patients take daily home measurements with an external electronics system and transmit the PAP data wirelessly for clinician review [18,19]. The recent studies showed that the CardioMEMS™ reduced HF hospitalizations and improved quality of life (Table 2) [46][47][48][49][50][51].…”

“…A wireless monitoring system (CardioMEMS™) detecting changes in PAP has been proposed for HF patients. CardioMEMS™ transmits data to the healthcare provider and allows to institute timely intensification of HF therapies [18][19][20]. In this narrative review, we aimed to provide an overview of telemedical monitoring and its impact on outcomes among HF patients; focusing on the advances of the CardioMEMS™ system.…”

The Future of Telemedicine in the Management of Heart Failure Patients

“…TM may also involve arrhythmia detection using ICD- or CRT-based algorithms or dedicated long-term implanted devices. [ 12 , 27 , 28 , 30 , 31 ]…”

Chronic disease management in heart failure: focus on telemedicine and remote monitoring

“…A remote pulmonary pressure-guided program usually requires a dedicated nurse or advanced practice provider with experience in heart failure supervised by a cardiologist. Administrative support is necessary for adequate billing to assure the sustainability of the program [76]. Hemodynamic-GUIDEd management of Heart Failure (GUIDE-HF) ongoing trial to evaluate the safety and efficacy of CardioMEMS TM in patients with HF and NYHA II-IV and symptomatic patients with elevated natriuretic peptides without recent heart failure hospitalization [77].…”