Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Pulmonary artery pressure-guided heart failure care reduced pulmonary artery pressure but did not result in higher doses of GDMT – observations from an early German HF cohort
B. Raghavan1, E. Herrmann1, N. Eissing2, S. Fichtlscherer3, B. Aßmus1
1Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 2Med. Klinik III - Kardiologie Zentrum der Inneren Medizin, Universitätsklinikum Frankfurt, Frankfurt am Main; 3Klinik für Kardiologie und Angiologie, Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH, Rotenburg an der Fulda;

Introduction: Remote pulmonary artery pressure (PAP)-guided heart failure (HF) therapy for NYHA class III HF patients has been shown to reduce hospitalizations and increased survival. We aimed to assess PAP over time and associated medication changes in a small German cohort of HF patients already receiving individually optimized HF medication.

Methods: We analyzed PAP, HF medication frequency and changes including diuretics in 24 patients with implanted PAP-sensor during the first 12 months of PAP-guided HF care in a Heart Failure Unit.

Results: During 12 months of PAP-guided HF therapy, PAP decreased significantly (ΛPAP systolic – 6 ± 10, ΛPAP diastolic – 4 ± 7, ΛPAP mean – 4 ± 8 mm Hg, p<0.01 for all). Only 16 % patients had an unplanned HF hospitalization. There was no significant change over time with respect to frequency and dosage of RAAS inhibition (ACE / ARB / ARNI), Beta-blocker or MRA treatment. In contrast, loop diuretic dosage (calculated as furosemide equivalent) increased significantly (2.1 ± 0.5 fold) over time. However, there was no difference between any of the baseline clinical, medication or HF hospitalization characteristics comparing the “responder” (PAP and diuretic doses decline) and “non-responder” (PAP and diuretic doses increase) patient group, with the “intermediate response” group.

Conclusion: In patients treated with individually optimized HF medication, no further evidence-based medication increase could be achieved using PAP-guided HF care. However, by individual adjustment of diuretic dose a significant decline in PAP over time occurred, which could not be predicted by any of the baseline characteristics.
 

https://dgk.org/kongress_programme/ht2021/P438.htm