Abstract 4358526: Concurrent Monitoring of Pulmonary Artery Diastolic Pressure (PADP) and Fluid Volume for More Accurate and Timely Detection of Worsening Heart Failure (HF)

Abstract

PADP monitoring is being increasingly utilized to guide remote HF management with PADP often used as a surrogate for volume status. Yet, in a prior HF study, it was observed that PADP was not correlated with total blood volume deviation (TBVD), and change in PADP was not correlated with change in TBVD. Thus, concurrent monitoring of volume and pressure may be more effective in detecting worsening HF compared to monitoring only pressure. We analyzed longitudinal data from 4 HF patients monitored daily with both a PADP monitor (CardioMEMS) and a peripheral volume monitor (Bodyport Cardiac Scale). The Cardiac Scale estimates a daily Congestion Index (CI) based on peripheral volume, volume change, and weight change. Worsening HF alerts were generated by CardioMEMS if the patient’s PADP goal was exceeded by more than a preset threshold, and by the Cardiac Scale if the CI exceeded a preset threshold. The CI and the CI alerts were not available to the clinicians. The study was coordinated by Keck Medical Center of USC. Patient 1 was a 64 year-old male (NYHA class III, LVEF:40%, PADP goal: 19mmHg, hypertension, diabetes). He had a HF hospitalization, which was alerted by both systems. The CI alerted it earlier and on both diuretic increases (days 84 and 96) over the 30 days prior to the hospitalization. PADP alert missed the diuretic increase on day 84. Patient 2 was a 74 year-old male (NYHA class III, LVEF:76%, PADP goal: 18mmHg, hypertension, hyperlipidemia, CVD). He had a HF hospitalization, which was alerted by both systems. The patient received an IV diuretic (day 204) over the 30 days prior to the hospitalization, which was alerted by both systems. Patient 3 was a 73 year-old female (NYHA class III, LVEF:70%, PADP goal: 22mmHg, hypertension, hyperlipidemia). She had no HF hospitalizations and very few alerts. Patient 3 had two diuretic increases; one of them (day 90) was detected by the CI and neither was detected by PADP. Patient 4 was a 68 year-old male (NYHA class III, LVEF:40%, PADP goal: 17mmHg, hypertension, hyperlipidemia, CVD). He had a HF hospitalization (day 163), which was alerted by the CI. Concurrent monitoring can benefit patients already with a PADP monitor. The CI detected a hospitalization missed by PADP, and it detected another one earlier than PADP. Both patients had lower EF, notable as cardiac filling pressure behavior varies with EF. Volume monitoring was patient-friendly and integrated simply within the daily weight measurement routine.