Remote telemonitoring for patients with heart failure: might monitoring pulmonary artery pressure become routine?

Abstract

Heart failure is one of the most important medical problems facing societies in developed economies and its prevalence is predicted to rise inexorably in the next few decades as longevity increases. Worsening heart failure leading to hospitalization is associated with a poor prognosis and imposes a substantial burden on health care resources and budgets. Interventions that can stabilize patients should reduce the need for hospitalization and improve prognosis. This might be facilitated by frequent self-monitoring of clinical and physiological variables by patients themselves at home. Rising pulmonary artery pressure is an early sign of cardiac decompensation that may be more sensitive than conventional methods of patient assessment and thus allow early adjustment of medical therapy to avoid hospitalizations and improve patient outcomes. Remote monitoring of pulmonary artery pressure is now possible using devices that can be implanted percutaneously. This innovative technology could become a routine part of the management of heart failure in the next few decades.

Keywords::

• heart failure
• implant
• invasive
• pulmonary hypertension
• pulmonary pressure
• telemonitoring

Financial & competing interests disclosure

JGF Cleland has received research support for telemonitoring from Philips and honoraria for speaking and advice from St Jude Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Heart failure is common and prognosis is often poor. It is a major health care burden.

• Many effective treatments exist but they are often poorly deployed.

• Home telemonitoring could improve the delivery of care.

• Hemodynamic monitoring may help optimize therapy; treating the underlying disease rather than symptoms and signs is more likely to alter the natural history of the disease favorably.

• Trials investigating therapy guided by invasive hemodynamic monitoring have shown promising results.

• Identifying the right patient, the right time to intervene and new therapies to improve hemodynamics are all likely to be the key to the success of a hemodynamic home telemonitoring strategy.

Notes