Rising Pulmonary Artery Pressures Precede Hospitalizations For Heart Failure But Not For Other Causes During Ambulatory Hemodynamic Monitoring For Chronic Heart Failure

Introduction In patients with previous heart failure hospitalization (HFH), ambulatory hemodynamic monitoring reduced HFH by 57% in the CardioMEMS Post-Approval Study (PAS), which translated into a 27% reduction in all-cause hospitalization but no change in other causes of hospitalization. We compared the trajectories of pulmonary artery pressures (PAP) before and after breakthrough HFH and the non-HF hospitalizations (non-HFH) that occurred during chronic PAP monitoring. Methods The PAS was a single arm study of 1200 patients with NYHA 3 HF (all EF) and prior HFH within 12 months who underwent implantation of a CardioMEMS PA sensor. An independent clinical events committee adjudicated all hospitalizations with primary cause HF and non-HF. We analyzed PAP changes during the 6 weeks prior and 1 week following hospitalization for all pts with PAP data through the 7 weeks, excluding overlapping analysis periods. Results Analysis was available for 751 hospitalizations, only 199 (26.5%) were HFH and 552 were (73.5%) were non-HFH. The rising trajectory of PAP changes in advance of HFH was distinct from non-HFH with an increase in pressure from baseline beginning approximately 4 weeks prior to HFH and a decrease in pressure observed immediately after HFH but no change observed before or after non-HFH. Conclusion Among patients with chronic HF across a range of EF, PAP rise approximately 4 weeks in advance of HFH and fall by 7 days after, but do not change around non-HFH. These data demonstrate the consistent physiology of rising PAP for breakthrough HFH that occur despite hemodynamic monitoring and the stability of PAP without elevation around the more common hospitalizations for other causes.