Changes in Upright Hemodynamics Preceding Heart Failure Events and Other Hospitalizations

Area of Science:

• Cardiology
• Biomedical Engineering
• Remote Patient Monitoring

Background:

• Remote monitoring of heart failure patients is crucial for timely intervention.
• Synchronous measurement of pulmonary artery pressure (PAP), weight, blood pressure (BP), and heart rate (HR) has not been evaluated for predicting heart failure events (HFE).
• Understanding pre-event physiological trends can improve patient outcomes.

Purpose of the Study:

• To compare trends in upright seated PAP with weight, BP, and HR before HFEs and other hospitalizations.
• To identify early warning signs for heart failure decompensation using remote monitoring data.
• To analyze the kinetics of PAP and vital signs in relation to different types of events.

Main Methods:

• Analysis of 24-month data from 456 patients in the PROACTIVE-HF trial using the CordellaTM HF device.
• Daily measurement and transmission of seated PAP, weight, BP, and HR.
• Trend analysis of parameters from 60 days before (D-60) to 30 days after (D+30) event day (D=0) for HFE, HF-TRE, and non-HFE.

Main Results:

• Mean PAP (mPAP) significantly increased from D-60 to D=0 (27.8±10.9 to 32.6±11.2 mmHg) prior to HFE, decreasing by D+30 (30.0±12.4 mmHg).
• PAP kinetics before HFE varied by LVEF; a faster rise was observed in patients with LVEF>40% compared to those with LVEF≤40%.
• No consistent changes in weight, SBP, or HR were observed before HFE; vital sign changes, but not mPAP, were noted before HF-TRE and non-HFE.

Conclusions:

• Upright seated mPAP increases weeks before HFE, serving as a potential early predictor.
• Vital signs (weight, BP, HR) do not show consistent pre-HFE trends, suggesting mPAP is a more reliable indicator.
• Differential PAP kinetics by LVEF suggest a need for more rapid intervention in LVEF>40% patients, and further validation is needed for vital sign changes in non-HFE and HF-TRE.