Changes in upright haemodynamics preceding heart failure events and other hospitalizations

IntroductionTrends in upright seated pulmonary artery pressure (PAP) with synchronous measurement of weight, blood pressure (BP), and heart rate (HR) have not been compared prior to heart failure events (HFE) and other causes of hospitalization during remote monitoring.

MethodWe analyzed 24-month data from patients in PROACTIVE-HF trial. Participants (N=456) used the CordellaTM HF daily to measure seated PAP, weight, BP, and HR, all taken and transmitted within minutes. Events that were analyzed included HFE, those potentially related to HF treatment (HF-TRE) and others (non-HFE). Parameters were trended from 60-days before (D-60) to 30-days after (D+30) the day of event (D=0), and their concurrent changes were compared between D-60 and D=0, and D=0 and D+30 using mixed effects model.

ResultsThere were 196 HFE, 276 non-HFE and 66 HF-TRE. Prior to HFE, average mean PAP (mPAP) increased from 27.8±10.9mmHg at D-60 to 32.6±11.2mmHg at D=0 (p<0.001), and decreased to 30.0±12.4mmHg at D+30 (p=0.001). Kinetics of mPAP before HFE differed by left ventricular ejection fraction (LVEF); mPAP rose by 3.4±6.8mmHg in 2-weeks before HFE in those with LVEF>40%, whereas a similar magnitude (3.1±9.1mmHg) of mPAP rise occurred over 6-weeks before HFE in those with LVEF≤40%. No consistent changes in weight, SBP or HR prior to HFE were observed (p>0.05). Changes in vital signs but not mPAP were noted prior to HF-TRE and non-HFE.

ConclusionSeated mPAP increased weeks in advance of HFE and vital signs did not change consistently before HFE. Differential kinetics of mPAP prior to HFE by the LVEF suggest that an uptrend in seated mPAP may need to be addressed more rapidly in those with LVEF>40%. Changes in vital signs with non-HFE and HF-TRE need further validation.