Background: Hemodynamically-guided management using an implanted pulmonary artery pressure sensor is a proven strategy for reducing heart failure (HF) hospitalizations. This approach is particularly beneficial for patients in New York Heart Association (NYHA) functional classes II-III who have a history of HF hospitalization or elevated natriuretic peptides.
Objectives: This study delves into the GUIDE-HF (Hemodynamic-GUIDEd management of Heart Failure) randomized trial to evaluate how left ventricular ejection fraction (EF) impacts treatment outcomes. Our objective is to provide a comprehensive Hf Guide by analyzing the effectiveness of hemodynamic-guided management across different EF subgroups.
Methods: The GUIDE-HF trial’s randomized arm included 1,000 patients with NYHA functional class II-IV heart failure. These patients, who had either experienced HF hospitalization within the previous year or had elevated natriuretic peptides (adjusted for EF and body mass index), were implanted with a pulmonary artery pressure sensor. Participants were then randomized in a 1:1 ratio into either a hemodynamically-guided management group (treatment) or a control group. The primary endpoint was a composite of HF hospitalizations, urgent HF visits, and all-cause mortality at 12 months. This analysis assesses outcomes based on guideline-defined EF subgroups: ≤40%, 41%-49%, and ≥50%, focusing on the pre-COVID-19 period cohort as specified in the trial.
Results: The treatment group experienced 177 primary events (0.553/patient-year), while the control group had 224 events (0.682/patient-year). This resulted in a hazard ratio (HR) of 0.81 [95% CI: 0.66-1.00]; P = 0.049, indicating a significant reduction in primary events with hemodynamically-guided management. Notably, HF hospitalization rates were significantly lower in the treatment group compared to the control group (HR: 0.72 [95% CI: 0.57-0.92]; P = 0.0072). Within each EF subgroup, both primary endpoint and HF hospitalization rates demonstrated a reduction in the treatment group (HR <1.0 across all EF spectrums). The reduction in event rates within the treatment groups, categorized by EF, was correlated with decreased pulmonary artery pressures and changes in medication regimens.
Conclusions: This HF guide highlights that hemodynamically-guided HF management effectively reduces HF-related endpoints across the entire EF spectrum. This benefit extends to a broader patient population suffering from heart failure, reinforcing the findings of the Hemodynamic-GUIDEd Management of Heart Failure [GUIDE-HF] trial (NCT03387813).
