Abstract 2556: Titration of Diuretics based on Heart Failure Treatment Strategies Utilizing Ambulatory Intra-cardiac Pressures
Introduction: The COMPASS-HF study evaluated whether patient management strategies (PMS) guided by the use of remotely monitored intra-cardiac pressures in a group of advanced heart failure (HF) patients, outside the hospital setting, reduced patient morbidity as measured by HF-related hospitalizations, emergency department visits and urgent clinic visits.
Methods: In COMPASS-HF, PMS were designed to assist clinicians in directing HF care based on patients’ volume status as determined by intra-cardiac pressure data and other relevant clinical information (e.g. daily weight, signs and symptoms). At each review of the implanted hemodynamic monitor (IHM) pressure data, conducted at least weekly during the six month randomized follow-up period, patients were classified as being in one of three pre-defined volume states: optivolemic, hypervolemic, or hypovolemic. When patients deviated from their established optivolemic state, an appropriate treatment strategy was implemented.
Results: One-hundred thirty-four (134) patients were randomized to the IHM group in COMPASS-HF. Four patients were excluded for the purpose of this analysis due to limited follow-up time with IHM directed care. Of the remaining 130 patients, 122 were determined to be in a state of hypervolemia at least once during their randomized follow-up period. Over the cumulative hypervolemic period, a total of 888 adjustments in diuretic treatment were made, or 3.75 changes per hypervolemic patient month (see Table⇓ below). In contrast, during the cumulative optivolemic period, diuretic medication adjustments occurred 550 times, or only 1.12 changes per optivolemic patient month.
Conclusions: These data may provide insight into the mechanism by which PMS guided by data from an IHM reduces HF morbidity, as regular determination of volume status using intra-cardiac pressure data significantly drives adjustments in a therapy known to modulate fluid and salt balance.