Universität zu Köln

Angermann, C. E. and Rosenkranz, S. (2018). Telemonitoring and pulmonary artery pressure-guided treatment of heart failure. Internist, 59 (10). S. 1041 - 1054. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-1289

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Abstract

Heart failure (HF) is an emerging epidemic associated with significant morbidity and mortality, impaired quality of life and high healthcare costs. Despite major advances in pharmacological and device-based therapies, mortality and morbidity have remained high after an index hospitalization for acute cardiac decompensation (ACD). Randomized trials evaluating various forms of noninvasive telemonitoring failed to improve rehospitalization rates in such patients, possibly due to lack of sensitivity of clinical signs and symptoms as early indicators of HF. Among different implantable monitoring devices, wireless remote monitoring of the pulmonary artery pressure (PAP) with the CardioMEMS sensor (Abbott, Sylmar, CA, USA) has been shown to be safe and clinically effective in the USA. The patients showed substantial reductions in hospital admissions for ACD, irrespective of left ventricular pump function, because PAP-guided HF management facilitates timely recognition of incipient ACD and appropriate modification of medical treatment before hospitalization becomes unavoidable. These encouraging results have also stimulated evaluation of this novel technology outside the USA. Studies are also underway in Europe and European HF guidelines recommend considering implantation of aCardioMEMS sensor in high-risk patients (class IIb-B). More technologically refined implantable hemodynamic monitoring systems allowing, for example, left atrial pressure measurements, are under development. Promising novel approaches to using information from such devices include continuous hemodynamic monitoring and patient self-management based on the pressure information. Thus, pressure-guided HF management is likely to further expand in the future and may help improve clinical outcomes also in high-risk HF populations.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Angermann, C. E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-171513
DOI:	10.1007/s00108-018-0495-1
Journal or Publication Title:	Internist
Volume:	59
Number:	10
Page Range:	S. 1041 - 1054
Date:	2018
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-1289
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DISEASE-MANAGEMENT; LIFETIME RISK; MORTALITY; HOSPITALIZATIONS; ADMISSION; CATHETERIZATION; EPIDEMIOLOGY; TRANSITION; NETWORK; GERMANY Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17151