Patient monitoring across the spectrum of heart failure disease management 10 years after the CHAMPION trial

Abstract

Despite significant advances in drug-based and device-based therapies, heart failure remains a major and growing public health problem associated with substantial disability, frequent hospitalizations, and high economic costs. Keeping patients well and out of the hospital has become a major focus of heart failure disease management. Achieving and maintaining such stability in heart failure patients requires a holistic approach, which includes at least the management of the underlying heart disease, the management of comorbidities and the social and psychological aspects of the disease, and the management of haemodynamic/fluid status. In this regard, accurate assessment of elevated ventricular filling pressures or volume overload, that is, haemodynamic or pulmonary congestion, respectively, before the onset of worsening heart failure symptoms represents an important management strategy. Unfortunately, conventional methods for assessing congestion, such as physical examination and monitoring of symptoms and daily weights, are insensitive markers of worsening heart failure. Assessment tools that directly measure congestion, accurately and in absolute terms, provide more actionable information that enables the application of treatment algorithms designed to restore patient stability, in a variety of clinical settings. Two such assessment tools, implantable haemodynamic monitors and remote dielectric sensing (ReDS), meet the prerequisites for useful heart failure management tools, by providing accurate, absolute, and actionable measures of congestion, to guide patient management. This review focuses on the use of such technologies, across the spectrum of heart failure treatment settings. Clinical data are presented that support the broad use of pulmonary artery pressure-guided and/or ReDS-guided heart failure management in heart failure patients with reduced and preserved left ventricular ejection fraction.

New Strategies to Prevent Rehospitalizations for Heart Failure

“…CardioMEMS initially showed 28% reduction of rehospitalization rates due to pulmonary artery hemodynamic monitoring in the 2016 CHAMPION trial [ 42 ]. Subsequent analyses have continued to show clinical benefit, with average reduction in HF hospitalizations ranging from 37 to 62% [ 43 ]. Success of this strategy is attributed to real-time output and associated appropriate adjustment of medical therapy [ 41 ••].…”

“…Remote assessment of lung congestion has also been studied through both non-invasive means utilizing a wearable device as well as by taking advantage of thoracic sensors in pacemakers and implantable cardioverter defibrillators. Though there are encouraging preliminary results specifically for reduction in cardiovascular readmissions using remote dielectric sensing technology (ReDS), which utilizes electromagnetic signals transmitted through the thorax, more information is needed to recommend these strategies for widespread use to prevent readmissions [ 41 ••, 43 , 45 ].…”

An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study

“…Advances in digital health have now made it possible to share medical information in real time, thus enabling more immediate management of chronic diseases. Remote patient monitoring solutions have been successfully developed in other chronic diseases, such as congestive heart failure and diabetes [12,13]. During the COVID-19 epidemic, patients of all demographic groups quickly adopted some form of technology to access medical care [14,15].…”

Acute decompensation of heart failure: state of the problem

“…В 2021 г. опубликована обзорная работа о мониторинге пациентов с ХСН [14], сфокусированная на определении и контроле выраженности отечного синдрома как критически важной составляющей картины СН вне зависимости от величины фракции выброса левого желудочка (ЛЖ) и степени компенсации клинической симптоматики. Авторы подчеркивают, что только 2 имеющиеся в клинической практике технологии отвечают требованиям точного, в абсолютных цифрах и применимого для клинических решений определения застоя жидкости: это имплантируемый гемодинамический монитор CardioMEMS и система ReDS.…”

“…Авторы подчеркивают, что описываемое медицинское изделие может использоваться специалистами со средним медицинским образованием, что указывает на сравнительную простоту процедуры. Более того, в статье упоминается «домашний» вариант устройства, который после должного обучения может использовать сам пациент для ежедневного мониторинга состояния (при условии передачи получаемых данных ответственному медицинскому персоналу с целью корректировки схемы применяющегося лечения при отклонении данных, получаемых с помощью системы ReDS, от нормальных значений) [14].…”