Translating Pressure Into Practice: Operational Characteristics of Ambulatory Hemodynamic Monitoring Program in the United States.
Hemodynamic monitoring
heart failure
pulmonary artery pressure
Journal
Journal of cardiac failure
ISSN: 1532-8414
Titre abrégé: J Card Fail
Pays: United States
ID NLM: 9442138
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
29
03
2023
revised:
17
05
2023
accepted:
29
05
2023
pubmed:
17
6
2023
medline:
17
6
2023
entrez:
16
6
2023
Statut:
ppublish
Résumé
Ambulatory hemodynamic monitoring (AHM) using an implantable pulmonary artery pressure sensor (CardioMEMS) is effective in improving outcomes for patients with heart failure. The operations of AHM programs are crucial to clinical efficacy of AHM yet have not been described. An anonymous, voluntary, web-based survey was developed and emailed to clinicians at AHM centers in the United States. Survey questions were related to program volume, staffing, monitoring practices, and patient selection criteria. Fifty-four respondents (40%) completed the survey. Respondents were 44% (n = 24) advanced HF cardiologists and 30% (n = 16) advanced nurse practitioners. Most respondents practice at a center that implants left ventricular assist devices (70%) or performs heart transplantation (54%). Advanced practice providers provide day-to-day monitoring and management in most programs (78%), and use of protocol-driven care is limited (28%). Perceived patient nonadherence and inadequate insurance coverage are cited as the primary barriers to AHM. Despite broad US Food and Drug Administration approval for patients with symptoms and at increased risk for worsening heart failure, the adoption of pulmonary artery pressure monitoring is concentrated at advanced heart failure centers, and modest numbers of patients are implanted at most centers. Understanding and addressing the barriers to referral of eligible patients and to broader adoption in community heart failure programs is needed to maximize the clinical benefits of AHM.
Sections du résumé
BACKGROUND
BACKGROUND
Ambulatory hemodynamic monitoring (AHM) using an implantable pulmonary artery pressure sensor (CardioMEMS) is effective in improving outcomes for patients with heart failure. The operations of AHM programs are crucial to clinical efficacy of AHM yet have not been described.
METHODS AND RESULTS
RESULTS
An anonymous, voluntary, web-based survey was developed and emailed to clinicians at AHM centers in the United States. Survey questions were related to program volume, staffing, monitoring practices, and patient selection criteria. Fifty-four respondents (40%) completed the survey. Respondents were 44% (n = 24) advanced HF cardiologists and 30% (n = 16) advanced nurse practitioners. Most respondents practice at a center that implants left ventricular assist devices (70%) or performs heart transplantation (54%). Advanced practice providers provide day-to-day monitoring and management in most programs (78%), and use of protocol-driven care is limited (28%). Perceived patient nonadherence and inadequate insurance coverage are cited as the primary barriers to AHM.
CONCLUSIONS
CONCLUSIONS
Despite broad US Food and Drug Administration approval for patients with symptoms and at increased risk for worsening heart failure, the adoption of pulmonary artery pressure monitoring is concentrated at advanced heart failure centers, and modest numbers of patients are implanted at most centers. Understanding and addressing the barriers to referral of eligible patients and to broader adoption in community heart failure programs is needed to maximize the clinical benefits of AHM.
Identifiants
pubmed: 37328050
pii: S1071-9164(23)00201-4
doi: 10.1016/j.cardfail.2023.05.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1571-1575Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest AB is a consultant for Abbott. TAB is on the speaker's bureau for Abbott, KB is on the speaker's bureau for Abbott, Pfizer, and Novartis and a consultant for Abbott. AS has received research funding from Abbott, Edwards Lifesciences, Vifor, Pfizer, Bayer, General Prognostics, Story Health, Acorai, Boston Scientific, and Impulse Dynamics; is on the steering committees of Abbott, Boston Scientific, Biotronik, Story Health, RIVUS, Bayer, and General Prognostics; and is a consultant for Abbott, Boston Scientific, Edwards Lifesciences, Impulse Dynamics, Acorai, Story Health, General Prognostics, and BayerMF; TH has received research support from Abbott and Impedimed; and is a member of the speaker's bureau for Actelion Pharmaceuticals, Medtronic, Abbott, Boehringer Ingelheim, Bayer, and Lily. JA is a member of the speaker's bureau for Abbott and Abiomed; a consultant for Abbott and Abiomed; and a member of the steering committee for Abbott and Abiomed. The remaining authors declare no conflicts.