Research in context
Evidence before this study
We searched PubMed and the Cochrane Library on July 6, 2015, with the search terms “haemodynamic [or hemodynamic] monitoring [or monitor]” and “heart failure”. Trials considered important included multicentre, randomised, controlled designs in patients with heart failure using implantable lead-based systems in the right ventricular outflow tract and implantable wireless systems in the pulmonary artery for ambulatory patient management, as well as pulmonary artery catheter assessment for acute patient management. We also found an ongoing multicentre, randomised, controlled implantable device trial using a lead-based system in the left atrium. Several small, open-label clinical investigations with short study durations of various implantable device systems were reviewed, but were unable to provide meaningful insights regarding long-term clinical benefits of these technologies in managing heart failure. A comprehensive Cochrane review of telemonitoring programmes for patients with chronic heart failure has been published that suggests the potential for long-term clinical benefit; however, few studies of haemodynamic monitoring were included in the review, which restricts its interpretation and direct application to the current dataset.
Added value of this study
Previous evidence has shown that haemodynamic-guided management of heart failure significantly reduced admissions to hospital after 6 months of testing. This study provides complete follow-up results from the CHAMPION trial showing sustained efficacy of haemodynamic-guided management of heart failure to reduce admissions to hospital, both during a randomised clinical trial setting, as well as in a follow-up setting more typical of clinical practice. Additionally, the combined risk of death or admission to hospital for heart failure was significantly reduced with a favourable trend towards a reduction in mortality. These data from 31 months of follow-up represent the longest follow-up of the effect of haemodynamic care ever reported.
Implications of all the available evidence
This study reports new findings that patients with chronic heart failure who are managed with pulmonary artery pressure information transmitted from an implantable device not only have better short-term clinical outcomes but also have significantly better long-term clinical outcomes than patients receiving guideline-directed standard of care management alone.