Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials

Iaconelli, A., Pellicori, P. , Caiazzo, E., Rezig, A. O. M. , Bruzzese, D., Maffia, P. and Cleland, J. G. F. (2023) Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials. Clinical Research in Cardiology, 112(8), pp. 1007-1019. (doi: 10.1007/s00392-022-02104-0) (PMID:36241896) (PMCID:PMC9568893)

Abstract

Background and aims: Congestion is a key driver of morbidity and mortality in heart failure. Implanted haemodynamic monitoring devices might allow early identification and management of congestion. Here, we provide a state-of-the-art review of implanted haemodynamic monitoring devices for patients with heart failure, including a meta-analysis of randomised trials. Methods and results: We did a systematic search for pre-print and published trials in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) on the 22nd of September 2021. We included randomised trials that compared management with or without information from implanted haemodynamic monitoring devices for patients with heart failure. Outcomes selected were hospitalisation for heart failure and all-cause mortality. Changes in treatment associated with haemodynamic monitoring resulted in only a small reduction in mean pulmonary artery pressure (typically < 1 mmHg as a daily average), which generally remained much greater than 20 mmHg. Haemodynamic monitoring reduced hospitalisations for heart failure (HR 0.75; 95% CI 0.58–0.96; p = 0.03) but not mortality (RR 0.92; 95% CI 0.68–1.26; p = 0.48). Conclusions: Haemodynamic monitoring for patients with heart failure may reduce the risk of hospitalization for heart failure but this has not yet translated into a reduction in mortality, perhaps because the duration of trials was too short or the reduction in pulmonary artery pressure was not sufficiently large. The efficacy and safety of aiming for larger reductions in pulmonary artery pressure should be explored.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: iaconelli, Dr antonio and Maffia, Professor Pasquale and CAIAZZO, Miss ELISABETTA and Cleland, Professor John and Rezig, Asma Oumkaltoum and Pellicori, Dr Pierpaolo
• Authors: Iaconelli, A., Pellicori, P., Caiazzo, E., Rezig, A. O. M., Bruzzese, D., Maffia, P., and Cleland, J. G. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 14 October 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Clinical Research in Cardiology 112(8):1007-1019
• Publisher Policy: Reproduced under a Creative Commons licence