Advanced Heart Failure: Cardiomems vs. Medical Management Only

  • Jackie Rice
  • Purdue Global University
  • MN 504 Scientific and Analytic Approaches to Advanced Evidence-Based Practice
  • Dr. Kristene Diggins
  • January 9, 2023

Advanced Heart Failure: Cardiomems vs. Medical Management Only

Some patients with heart failure (HF) progress to advanced heart failure. This number is growing notably, an aspect attributed to a host of factors, including the increasing prevalence rate and improved survival of HF patients and increasing population aging (Subramaniam et al., 2022; Tomasoni et al., 2022). As a result, many clinicians experience treatment challenges because the patients develop severe symptoms and impaired quality of life, making them less responsive to treatment therapies and at enhanced risk of hospitalizations and death (Tomasoni et al., 2022). In line with this assertion, it is prudent for clinicians to adopt interventions that could help in reducing reoccurring hospital admissions. Therefore, this paper compares the efficacy of Cardiomems device implant versus only medical management in reducing reoccurring hospital admissions.

Discussion

Clinical Question

The clinical question this paper explores is: In advanced heart failure patients (P), how does Cardiomems device implantation (I) compared to only medical management (C) reduce reoccurring hospital admissions (O) after the first year of device use (T)?

Databases

Several databases were considered appropriate sources of evidence-based references related to the clinical question. However, two electronic databases, CINAHL and PubMed, were considered most appropriate and used to search for references relevant to the clinical question. Search terms used included ‘Cardiomems device implantation,’ ‘advanced heart failure medical management,’ ‘advanced heart failure,’ and ‘advanced heart failure therapies.’

 

Evidence-Based References

The search identified ten evidence-based references. Four references were excluded as they were more than five (5) years, while one (1) was excluded as they did not relate to either of the two interventions. Another reference was excluded as it was not a research article but a commentary article; hence considered appropriate and relevant for the clinical question. Four (4) evidence-based references were considered relevant to the clinical question. These references include Brugts et al. (2021), Volterrani et al. (2019), Assaad et al. (2019), and Abraham et al. (2020). The references were analyzed for evidence regarding the PICOT questions. The findings are presented in the next section.

Findings from the Evidence-Based References

The obtained evidence-based references showed that the Cardiomems device implant reduced reoccurring hospital admissions compared to only medical management. In the first evidence-based reference, Brugts et al. (2022) analyzed and summarized clinical evidence for remote patient care for an HF patient using Cardiomems. In this article, Brugts et al. (2022) described the Cardiomems device as capable of monitoring pulmonary artery pressure remotely, enabling clinicians to implement proactive medical interventions. In this evidence-based reference, Brugts et al. (2022) cited the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial published in 2011 as the first clinical trial that proved that implantable devices such as Cardiomems could reduce the number of HF hospitalizations. The study involved 550 advanced HF patients, with 270 patients on the Cardiomems HF system and a control group comprising 280 patients (Brugts et al., 2022). The results revealed that the control group had 120 advanced HF hospitalizations while the Cardiomems group had 84 hospitalizations (Brugts et al., 2022). A 6-month follow-up showed that HF-related hospitalizations for the Cardiomems/treatment group reduced by 37% compared to the control group. In the second evidence-based reference, Volterrani et al. (2019) analyzed the use of implantable devices for advanced HF management. They focused on the Cardiomems device. They based their analysis on a sub-study conducted on 245 Medicare-eligible subjects. The results revealed a 49% reduction in HF-related hospitalizations in the treatment group compared to the control group. In the third evidence-based reference, Assaad et al. (2019) explored the effectiveness of the Cardiomems device in reducing HF-related readmissions. In their study involving 27 patients, the total number of HF-related hospitalizations prior to Cardiomems implantation was 46 compared to 9 hospital readmissions post Cardiomems device implantation (Assaad et al., 2019). According to Assaad et al. (2019), there was an 80.4% reduction in HF-related hospitalizations compared to the control group. In the fourth evidence-based reference, Abraham et al. (2020) summarized published data on Cardiomems. Their analysis revealed a 28% reduction in HF-related hospital admissions among patients with Cardiomems implants compared to patients receiving standard care (Abraham et al., 2020). The findings from these four evidence-based references show that the Cardiomems device implant significantly reduced hospital reoccurring HF-related hospitalizations compared to only medical management/standard care.

Conclusion

This paper has explored the efficacy of the Cardiomems device in advanced heart failure management compared to only medical management. Findings from the four evidence-based references obtained from CINAHL and PubMed databases revealed that the Cardiomems device significantly reduced HF-related reoccurring hospitalizations compared to standard care. Based on this finding, clinicians and healthcare systems should consider adopting this device in patient care for advanced HF patients. This intervention will enable them to monitor patients remotely and take proactive therapeutic interventions to prevent reoccurring hospitalizations.

 

References

Abraham, J., McCann, P.J., Guglin, M.E., Bhimaraj, A., Benjamin, T.S., Robinson, M.R., Jonsson, O.T., Feitell, S.C., Bhatt, K.A., Bennett, M.K., Heywood, J.T., & Hemodynamic Frontiers in Heart Failure (HF2) Investigators (2020). Management of the patient with heart failure and an implantable pulmonary artery hemodynamic sensor. Current Cardiovascular Risk Reports, 14, 12. https://doi.org/10.1007/s12170-020-00646-4

Assaad, M., Sarsam, S., Naqvi, A., & Zughaib, M. (2019). CardioMemsVR device implantation reduces repeat hospitalizations in heart failure patients: A single center experience. JRSM Cardiovascular Disease, 8, 1-7. http://dx.doi.org/10.1177/2048004019833290

Brugts, J. J., Radhoe, S. P., Aydin, D., Theuns, D. A., & Veenis, J. F. (2021). Clinical update of the latest evidence for CardioMEMS pulmonary artery pressure monitoring in patients with chronic heart failure: A promising system for remote heart failure care. Sensors (Basel, Switzerland), 21(7), 2335. https://doi.org/10.3390/s21072335

 Subramaniam, A. V., Weston, S. A., Killian, J. M., Schulte, P. J., Roger, V. L., Redfield, M. M., Blecker, S. B., & Dunlay, S. M. (2022). Development of advanced heart failure: A population-based study. Circulation Heart Failure, 15(5), e009218. https://doi.org/10.1161/CIRCHEARTFAILURE.121.009218

Tomasoni, D., Vishram-Nielsen, J. K. K., Pagnesi, M., Adamo, M., Lombardi, C. M., Gustafsson, F., & Metra, M. (2022). Advanced heart failure: Guideline-directed medical therapy, diuretics, inotropes, and palliative care. ESC Heart Failure, 9(3), 1507–1523. https://doi.org/10.1002/ehf2.13859

Volterrani, M., Spoletini, I., Angermann, C., Rosano, G., & Coats, A. J. (2019). Implantable devices for heart failure monitoring: the CardioMEMS™ system. European Heart Journal Supplements: Journal of the European Society of Cardiology, 21(Suppl M), M50–M53. https://doi.org/10.1093/eurheartj/suz265