Haemodynamic monitoring improves quality of life and lowers hospitalisations in HF patients

Remote pulmonary artery pressure monitoring met all primary and secondary endpoints in the MONITOR-HF trial. This was the first positive study of remote monitoring in European patients.

Remote monitoring of pulmonary artery pressures (PAP) has emerged as the most successful technique for ambulatory hemodynamic monitoring in heart failure (HF) patients. PAP is a marker of haemodynamic congestion, which occurs several weeks before symptoms develop, providing a possibility for early intervention. But can assessing haemodynamic congestion based on filling pressures instead of clinical congestion be a way to further improve quality of life (QoL) and clinical outcomes? To answer this question, the multi-centre randomised clinical MONITOR-HF (NTR7672) study was performed including 348 participants with chronic HF in the Netherlands [1]. All participants were in NYHA call III and had at least 1 HF hospitalisation in the previous 12 months. They were randomized (1:1) either to standard of care or to pulmonary artery guided therapy. The latter received a small, wireless sensor implanted into the pulmonary artery via the femoral vein.

The primary endpoint of this open-label trial was quality of life, assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 12 months. Total HF hospitalisations were assessed as a secondary outcome.

All 348 patients had a mean age of 69 and an “appropriate background therapy” as put by Dr Jasper Brugts (Erasmus University Medical Centre, Rotterdam, the Netherlands). Their mean ejection fraction was 30%.

At 12 months, the average change in the KCCQ overall summary score improved by +7 points in the monitoring group and -0.2 points in the usual care group, yielding a mean difference between groups of 7.1 points in favour of monitoring (P=0.013). This difference persisted during the follow-up period of 1.8 years. In this time, there were 117 heart failure hospitalisations or urgent visits in the monitoring group compared with 212 in the usual care group. “This is a meaningful difference and represents a 44% reduction in HF hospitalisation”, Dr Brugts emphasized during the presentation of the results (HR 0.56; 95% CI 0.38–0.84; P<0.01).

Subgroup analyses showed that this treatment benefit was consistent in subgroups with an ejection fraction of ≤40% and >40%. In the intervention group, a significant reduction in NT-proBNP was seen.

Dr Brugts explained that the positive effect is induced primarily by changes in diuretics. Diuretics could be optimised based on pulmonary artery pressures as a surrogate of left ventricular filling pressures. Therefore, patients in the intervention group have been in a chronically better decongestive state. Moreover, the implant technology showed to be safe and reliable.

1. Brugts J. Remote hemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): A randomised controlled clinical trial. Session “Late breaking clinical trials: Chronic HF and cardiomyopathies”, Heart Failure 2023, 20–23 May, Prague, Czechia.

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Posted on 23 May, 20237 June, 2023