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Program Overview

The national challenge: The American Heart Association (AHA) estimates that currently approximately 5 million Americans have heart failure (HF) and that this will increase to nearly 8 million by 2030, when nearly 1 in every 33 Americans will have HF. The current cost of HF is around $30 billion annually, and this is projected to double to $60 billion annually by 2030. Nearly 80% of the direct cost associated with HF care is associated with hospitalization, and HF is the leading cause for hospitalizations in the Medicare-age population in the United States. The patient problem: At least half of patients coming into the hospital with worsening symptoms do so because they developed volume overload and worsening congestion, and one of the biggest predictors of their risk for readmission is the efficacy of decongestion during the hospital stay. The HF management challenge: Thus congestion is an important target for optimal management of patients, and longitudinal monitoring for recurrence of congestion may be a critical target for this. It is estimated that management of this may result in a 25% reduction in overall mortality, a 26% reduction in HF readmissions, and about a 19% reduction in hospitalization for any cause over the course of time. The challenge is that rises in filling pressures occur outside of hospital and as a result physicians must rely on patient reporting – but frequently patients are not aware of symptoms until too late and they have presented to the emergency department. While it seems intuitively clear that telling patients to monitor their daily weights, it is not clear that this provides for any better management of HF patients – but if daily weights are not effective, what other strategies are available? The management question: What are clinicians really trying to get at with weights, changes in impedance, or heart rate variability changes? The answer is changes in filling pressure, which it has not been possible to measure directly. In other words, perhaps the signal that we have been missing in longitudinal HF management is the ability to directly monitor filling pressures, and pulmonary artery pressure (PAP) in particular. The new measurement device: Direct PAP measurement with an implantable device has been introduced and recently assessed in the CHAMPION trial. CHAMPION assessed managing PAP levels directly using an implantable device so that regardless of patient signs or symptoms, regardless of whether or not the patient felt well, and regardless of whether the clinician thought that the patient looked well, the treating physicians were encouraged to lower patient PAP levels into defined target ranges. The results were significant and clinically meaningful reductions in HF hospitalizations and readmissions, including lower 30-day readmissions, in all subgroups (reduced or preserved EF; all important comorbidities, especially COPD), and a suggestion that PAP-guided management could produce a reduction in risk of mortality.

Learning Objectives

Upon reading and interacting with this publication, readers should be able to:

  • Review the challenge of heart failure (HF), and congested HF in particular, in the healthcare system.
  • Discuss the longitudinal management of volume overload and congestion in HF patients.
  • Summarize the use of, and results with, a new implantable hemodynamic (pulmonary artery pressure) monitoring device.

Target Audience

Physicians and clinicians who see patients with heart failure at risk for volume overload and congestion, and who need to plan and implement strategies for longitudinal and integrated management of these patients.

Author Affiliations and Financial Disclosures

The authors are solely responsible for the content of this publication and make the following financial disclosures:

William T Abraham, MD
The Ohio State University Wexner Medical Center
Davis Heart and Lung Research Institute
The Ohio State University
Columbus, Ohio

Dr Abraham discloses the following financial relationships:

  • Advisor/consultant: St. Jude Medical, Inc.

Dr Abraham does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Abraham does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Akshay S. Desai, MD, MPH
Brigham Cardiovascular Consultants
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts

Dr Desai discloses the following financial relationships:

  • Advisor/consultant: St. Jude Medical

Dr Desai does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Desai does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

James (Tom) Heywood, MD
Comprehensive Heart Failure & MCS Program
Heart Failure Recovery & Research Program
Pulmonary Hypertension Program
Scripps Clinic Torrey Pines
La Jolla, California

Dr Heywood discloses the following financial relationships:

  • Honoraria or consulting fees: St. Jude Medical

Dr Heywood does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Heywood does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Laura Yamokoski, APN
Heart Failure Research Program
The Ohio State University Wexner Medical Center
Columbus, Ohio

Laura Yamokoski reports no financial relationships to disclose.

Laura Yamokoski does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Laura Yamokoski does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Statement of Peer Review

This multimedia publication was reviewed and approved for publication by the editorial office of The American Journal of Cardiology.

Disclaimer Statement

The opinions or views expressed on this publication are those of the authors and do not necessarily reflect the opinions and recommendations of the publisher or supporters. Articles may discuss pharmaceutical products and/or use of products that have not been approved by the US Food and Drug Administration or other regulatory authorities outside the United States. Dosages, indication, and methods of use for compounds that are referred to by the presenters/authors may reflect their clinical experience or may be derived from the professional literature or other sources. For approved product information, consult the manufacturer's prescribing information or the applicable regulatory authority.

 

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