Early Reduction of Pulmonary Artery Pressures Is Associated With Improved Mortality Among Medicare Beneficiaries With...

The early hemodynamic trajectories of heart failure patients receiving implantable pulmonary artery pressure monitor and the clinical implications of those trajectories are unknown in a contemporary real-world population.

This study aims to determine whether baseline pulmonary artery diastolic pressure (PAD) and its early trajectories predict risk of mortality.

Patients in Merlin.net implanted with the CardioMEMS sensor between 2017 and 2022 were linked to Medicare claims. Patients were categorized by PAD being acceptable (≤20 mm Hg) or elevated (>20 mm Hg). Multivariable regression was used to evaluate the impact of baseline PAD (cohort A) and its early changes at 90 days (cohort B) on long-term mortality.

In cohort A (N = 9,579), baseline PAD was elevated in 64.1%. The 2-year risk of mortality was lower for those with acceptable vs elevated PAD at baseline (HR: 0.68 [95% CI: 0.62-0.73]; P < 0.001). In cohort B (N = 8,452), 63.3% had elevated PAD at baseline; of those, 24.0% improved to having acceptable PAD (Δ: -6.5 ± 4.3 mm Hg), and 76.0% remained persistently elevated at 90 days despite experiencing a reduction (ΔPAD: -1.6 ± 4.3 mm Hg). Those with improved PAD (acceptable at 90 days from elevated at baseline) had lower mortality compared with those with persistently elevated PAD (HR: 0.72 [95% CI: 0.64-0.81]; P < 0.001). Lower baseline PAD and no history of chronic obstructive pulmonary disease or atrial arrhythmia were associated with higher odds of improved PAD.

Among Medicare beneficiaries, CardioMEMS-guided management was associated with a reduction in PAD. Achieving acceptable PAD within 90 days of implant was associated with better survival. Our study highlights the need to develop novel strategies, including standardization of management algorithms that target elevated PAD.