Pulmonary artery pressure (PAP) monitoring with the CardioMEMS device reduces heart
failure (HF) hospitalizations and improves quality of life in NYHA Class III HF. The
aim of this study was to evaluate the CardioMEMS device in a real-world Canadian HF
cohort and explore its economic impact.
METHODS AND RESULTS
21 patients with NYHA Class III HF underwent CardioMEMS implantation at Foothills
Medical Centre, Calgary, Alberta. Baseline, 3, 6, 9, and 12-month assessments of laboratory
parameters, hemodynamics, 6-minute walk test (6-MWT) and Kansas City Cardiomyopathy
Questionnaire (KCCQ12) scores were prospectively collected. Healthcare costs for the
1-year pre and post-implant were collected from administrative databases. Of 21 patients,
19 patients had useable data (1 unsuccessful implant, 1 pressure dampening due to
small implant artery). There were no procedural complications. Mean age was 68.9 years,
45% were female, 10% HFpEF. Of those with HFrEF, mean LVEF at baseline was 31%. Over
a mean follow-up of 10 months, there was an 85% reduction in HF ER visits (p=0.0003),
83% reduction in HF hospitalizations (p < 0.001), 79% decrease in all-cause hospitalizations
(p=0.0006), 41% decrease in HF clinic visits (p=0.034), and a 151% increase in nurse
clinician calls (p < 0.0001) observed. KCCQ-12 scores and 6-MWT at baseline vs. last
follow-up were 45.7 vs. 47.1 (p=0.76) and 364.4 vs. 402.3 m (p=0.59), respectively.
NT-proBNP and mean PAP at baseline vs. last follow-up were 2277.2 vs. 1509.9 pg/mL
(p=0.28) and 31.5 vs. 24.4 mmHg (p=0.0024), respectively. NYHA class improved at least
one class in 74% of patients. Fourteen patients have completed 1 year of follow-up.
Table 1 outlines healthcare utilization costs 1-year pre and post-implant (n=14).
Total measurable HF-related spending pre-implantation was $324 795. The cost of measurable
HF spending in the year post-implantation was $108 763. When considering device cost,
the net cost at 1-year was $386 558, equating to an additional $4 412 per patient.
CardioMEMS remote monitoring demonstrated reductions in PA pressures, hospitalizations,
ER visits, clinic visits and improvement in NYHA class in NYHA III HF. There was no
significant difference in KCCQ12 scores, 6MWT or NT-proBNP limited by short duration
of follow up. Cost-parity was nearly achieved at 1-year post-implantation, driven
predominantly by a significant reduction in hospitalization costs. Though further
economic evaluation is needed, these results support the use of ambulatory PA pressure
monitoring as a cost-effective method of HF management in a publicly funded healthcare