Advertisement
Canadian Journal of Cardiology

AMBULATORY PULMONARY ARTERY PRESSURE MONITORING REDUCES COSTS AND IMPROVES OUTCOMES IN SYMPTOMATIC HEART FAILURE: A SINGLE-CENTER CANADIAN EXPERIENCE

      BACKGROUND

      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.

      CONCLUSION

      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 system.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect