Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides
Copyright © 2023. Published by Elsevier Inc..
BACKGROUND: In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs).
OBJECTIVES: This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH.
METHODS: In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models.
RESULTS: Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58).
CONCLUSIONS: Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813).
| Errataetall: |
CommentIn: JACC Heart Fail. 2023 Jun;11(6):699-701. - PMID 37178082 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
JACC. Heart failure - 11(2023), 6 vom: 13. Juni, Seite 691-698 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Desai, Akshay S [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.06.2023 Date Revised 13.06.2023 published: Print-Electronic ClinicalTrials.gov: NCT03387813 CommentIn: JACC Heart Fail. 2023 Jun;11(6):699-701. - PMID 37178082 Citation Status MEDLINE |
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| doi: |
10.1016/j.jchf.2023.01.007 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357881095 |
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| 245 | 1 | 0 | |a Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides |
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| 500 | |a Date Completed 09.06.2023 | ||
| 500 | |a Date Revised 13.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03387813 | ||
| 500 | |a CommentIn: JACC Heart Fail. 2023 Jun;11(6):699-701. - PMID 37178082 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023. Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs) | ||
| 520 | |a OBJECTIVES: This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH | ||
| 520 | |a METHODS: In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models | ||
| 520 | |a RESULTS: Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58) | ||
| 520 | |a CONCLUSIONS: Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813) | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a ambulatory hemodynamic monitoring | |
| 650 | 4 | |a heart failure | |
| 650 | 4 | |a heart failure hospitalization | |
| 650 | 4 | |a natriuretic peptides | |
| 650 | 4 | |a remote monitoring | |
| 650 | 7 | |a Natriuretic Peptides |2 NLM | |
| 700 | 1 | |a Maisel, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Mehra, Mandeep R |e verfasserin |4 aut | |
| 700 | 1 | |a Zile, Michael R |e verfasserin |4 aut | |
| 700 | 1 | |a Ducharme, Anique |e verfasserin |4 aut | |
| 700 | 1 | |a Paul, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Sears, Samuel F |e verfasserin |4 aut | |
| 700 | 1 | |a Smart, Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Bhatt, Kunjan |e verfasserin |4 aut | |
| 700 | 1 | |a Krim, Selim |e verfasserin |4 aut | |
| 700 | 1 | |a Henderson, John |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Nessa |e verfasserin |4 aut | |
| 700 | 1 | |a Adamson, Philip B |e verfasserin |4 aut | |
| 700 | 1 | |a Costanzo, Maria Rosa |e verfasserin |4 aut | |
| 700 | 1 | |a Lindenfeld, JoAnn |e verfasserin |4 aut | |
| 700 | 0 | |a GUIDE-HF Investigators |e verfasserin |4 aut | |
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