Akshay S. Desai, Arvind Bhimaraj, Rupinder Bharmi, Rita Jermyn, Kunjan Bhatt, David Shavelle, Margaret M. Redfield, Robert Hull, Jamie Pelzel, Kevin Davis, Nirav Dalal, Philip B. Adamson, J. Thomas Heywood

In the CHAMPION trial, heart failure hospitalization (HFH) rates were lower in patients managed with guidance from an implantable pulmonary artery pressure (PAP) sensor compared to usual care. To examine the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside the clinical trial setting. We conducted a retrospective cohort study using US Medicare claims data from patients undergoing PAP sensor implantation between 6/1/2014 and 12/31/2015. Rates of HFH during predefined periods before and after implantation were compared using the Andersen-Gill extension to the Cox proportional hazards model while accounting for the competing risk of death, ventricular assist device (VAD), or cardiac transplantation. Comprehensive HF-related costs were compared over the same periods. Among 1114 implanted patients, there were 1020 HFH in the 6 months before, compared with 381 HFH, 139 deaths, and 17 VAD/transplants in the 6 months after implantation (HR 0.55, 95%CI 0.49-0.61, p < 0.001). This lower rate of HFH was associated with a 6-month comprehensive HF cost reduction of $7,433 per patient (95%CI, $7,000-7,884) and was robust in analyses restricted to 6-month survivors. Similar reductions in HFH and costs were noted in the subset of 480 patients with complete data available for 12 months before and after implantation (HR 0.66, 95%CI 0.57-0.76, P<0.001). As in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice reduces HFH and comprehensive HF costs. These benefits are sustained to one year and support the 'real world' effectiveness of this approach to HF management.