Curtain, J. P., Lee, M. M.Y. , McMurray, J. J.V. , Gardner, R. S., Petrie, M. C. and Jhund, P. S. (2023) Efficacy of implantable haemodynamic monitoring in heart failure across ranges of ejection fraction: a systematic review and meta-analysis. Heart, 109(11), pp. 823-831. (doi: 10.1136/heartjnl-2022-321885) (PMID:36522146) (PMCID:PMC10314022)
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Abstract
Aims: We conducted a meta-analysis of randomised controlled trials (RCTs) of implantable haemodynamic monitoring (IHM)-guided care. Methods: PubMed and Ovid MEDLINE were searched for RCTs of IHM in patients with heart failure (HF). Outcomes were examined in total (first and recurrent) event analyses. Results: Five trials comparing IHM-guided care with standard care alone were identified and included 2710 patients across ejection fraction (EF) ranges. Data were available for 628 patients (23.2%) with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%) and 2023 patients (74.6%) with heart failure with a reduced ejection fraction (HFrEF) (EF <50%). Chronicle, CardioMEMS and HeartPOD IHMs were used. In all patients, regardless of EF, IHM-guided care reduced total HF hospitalisations (HR 0.74, 95% CI 0.66 to 0.82) and total worsening HF events (HR 0.74, 95% CI 0.66 to 0.84). In patients with HFrEF, IHM-guided care reduced total worsening HF events (HR 0.75, 95% CI 0.66 to 0.86). The effect of IHM-guided care on total worsening HF events in patients with HFpEF was uncertain (fixed-effect model: HR 0.72, 95% CI 0.59 to 0.88; random-effects model: HR 0.60, 95% CI 0.32 to 1.14). IHM-guided care did not reduce mortality (HR 0.92, 95% CI 0.71 to 1.20). IHM-guided care reduced all-cause mortality and total worsening HF events (HR 0.80, 95% CI 0.72 to 0.88). Conclusions: In patients with HF across all EFs, IHM-guided care reduced total HF hospitalisations and worsening HF events. This benefit was consistent in patients with HFrEF but not consistent in HFpEF. Further trials with pre-specified analyses of patients with an EF of ≥50% are required. PROSPERO registration number: CRD42021253905.
| Item Type: | Articles |
|---|---|
| Additional Information: | JJVM, MCP and PSJ are supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Gardner, Professor Roy and Lee, Matthew and Curtain, Dr James and Jhund, Professor Pardeep and Petrie, Professor Mark and McMurray, Professor John |
| Authors: | Curtain, J. P., Lee, M. M.Y., McMurray, J. J.V., Gardner, R. S., Petrie, M. C., and Jhund, P. S. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Heart |
| Publisher: | BMJ Publishing Group |
| ISSN: | 1355-6037 |
| ISSN (Online): | 1468-201X |
| Published Online: | 15 December 2022 |
| Copyright Holders: | Copyright © 2022 The Authors |
| First Published: | First published in Heart 109(11):823-831 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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