Abstract 19396: Diuretic Use Guided by a Wireless Implanted Pulmonary Artery Pressure Monitoring System in NYHA Class III Heart Failure Patients: Observations from the CHAMPION Trial
Introduction: Optimal diuretic dosing strategies for the treatment of chronic heart failure (HF) have not been established. The range of effective diuretic doses varies widely from patient to patient and within patient from time to time. Knowledge of wirelessly measured Pulmonary Artery Pressure (w-PAP) can provide immediate feedback on treatment response and thus may help identify an optimal diuretic strategy.
Methods: Retrospective analysis of CHAMPION trial data to determine if adjustments of diuretic therapy in response to w-PAP are associated with reduced HF hospitalization rates.
Results: In the CHAMPION trial 270 patients were assigned to w-PAP and 280 to usual care (UC). At baseline w-PAP and UC groups were similar in percentage of patients receiving diuretics (91.9% and 94.2%) and diuretics doses. Over a 6 month follow up period loop diuretics were more frequently adjusted in the w-PAP than in the UC group (1267 vs. 498 times; p<0.0001). In the w-PAP group 629 diuretic adjustments (49.8%) in 155 patients (57.4%) resulted from detection of increases in PAP and 107 diuretic changes (75.4%) in 46 patients (17%) occurred after detection of declining PAP. Compared to baseline, 6 months daily loop diuretic dose increased from 96.8 mg to 122.7 mg in the w-PAP group and 98.0 mg to 112.4 in the UC group. Despite more frequent diuretic adjustments in the w-PAP than in the UC group, mean daily loop diuretic dose changes were similar between groups (25.9 mg vs. 14.3 mg; p=0.1214). The 89 w-PAP patients with increased loop diuretic dose had a lower rate of HF hospitalizations than the 68 UC patients with similarly increased diuretic doses (0.32 vs. 0.70; p= 0.0014. In contrast HF hospitalization rates were similar in the 134 w-PAP and 173 UC patients without diuretic dose change (0.28 vs.0.27).
Conclusions: Utilization of w-PAP permits physicians to effectively increase and decrease diuretic doses and reduce HF hospitalizations rates. Such adjustments in diuretic doses without knowledge of w-PAP are associated with a high 6-month rate of HF hospitalizations.
- © 2012 by American Heart Association, Inc.