Heart failure (HF) has a large societal and economic burden and is expected to increase in magnitude and complexity over the ensuing years. A number of telemonitoring strategies exploring remote monitoring and management of clinical signs and symptoms of congestion in HF have had equivocal results. Early studies of remote haemodynamic monitoring showed promise, but issues with device integrity and implantation-associated adverse events hindered progress. Nonetheless, these early studies established that haemodynamic congestion precedes clinical congestion by several weeks and that remote monitoring of intracardiac pressures may be a viable and practical management strategy. Recently, the safety and efficacy of remote pulmonary artery pressure-guided HF management was established in a prospective, single-blind trial where randomisation to active pressure-guided HF management reduced future HF hospitalisations. Subsequent commercial use studies reinforced the utility of this technology and post hoc analyses suggest that tight haemodynamic management of patients with HF may be an additional pillar of therapy alongside established guideline-directed medical and device therapy. Currently, there is active exploration into utilisation of this technology and management paradigm for the timing of implantation of durable left ventricular assist devices (LVAD) and even optimisation of LVAD therapy. Several ongoing clinical trials will help clarify the extent and utility of this strategy along the spectrum of patient with HF from individuals with chronic, stable HF to those with more advanced disease requiring heart replacement therapy.
- heart failure
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Contributors The contributions of the authors are as follows: DMS: conception and design, drafting of the manuscript, revising the manuscript critically for important intellectual content and final approval of the submitted version. AMW: drafting of the manuscript, revising the manuscript critically for important intellectual content and final approval of the submitted version. LG: conception and design, revising the manuscript critically for important intellectual content and final approval of the submitted version. MF and JR: revising the manuscript critically for important intellectual content and final approval of the submitted version. None of the authors had any writing assistance.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DMS, LG, JR and AMW are on the speakers' bureau for Abbott Vascular, the manufacturer of the CardioMEMS HF System. DMS, LG, JR and MF receive research support from Abbott Vascular.
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Provenance and peer review Commissioned; externally peer reviewed.