Pulmonary Artery Pressure-Guided Therapy for Heart Failure Patients: Rationale and Challenges

Increased body weight more than 2 lbs. over night or 5 lbs. over 3 days.

Clinical exam findings of elevated jugular venous distention, third heart sound, pulmonary rales, and/or bilateral pedal edema.

Decreased intra thoracic impedance using data from cardiac implantable electronic devices (e.g. CorVue, Optivol).

Increased pulmonary artery diastolic pressures from implantable hemodynamic monitors (e.g. CardioMEMS).

Optimize guideline-directed medical therapy

Adjust diuretics, then vasodilators

Adjust vasodilators, then diuretics

Advise dietary modification initially, then adjust diuretics

More medication dose adjustments

The same number of dose adjustments

Fewer dose adjustments

Diuretic doses were higher at the end of study in the blinded therapy group

Diuretic dose increases were more frequent in the active monitoring group

Diuretic dose increases were balanced by diuretic dose decreases in the active monitoring group

Diuretic dose decreases were more frequent in the blinded therapy group

eGFR declined more in the active treatment arm

eGFR declined more in the blinded therapy arm

There was no difference in eGFR decline between the treatment groups

First Name & Last Name