Translating Pressure Into Practice: Operational Characteristics of Ambulatory Hemodynamic Monitoring Program in the United States.

Background: Ambulatory hemodynamic monitoring (AHM) using an implantable pulmonary artery pressure sensor (CardioMEMS) is effective in improving outcomes for patients with heart failure. The operations of AHM programs are crucial to clinical efficacy of AHM yet have not been described.
Methods and Results: An anonymous, voluntary, web-based survey was developed and emailed to clinicians at AHM centers in the United States. Survey questions were related to program volume, staffing, monitoring practices, and patient selection criteria. Fifty-four respondents (40%) completed the survey. Respondents were 44% (n = 24) advanced HF cardiologists and 30% (n = 16) advanced nurse practitioners. Most respondents practice at a center that implants left ventricular assist devices (70%) or performs heart transplantation (54%). Advanced practice providers provide day-to-day monitoring and management in most programs (78%), and use of protocol-driven care is limited (28%). Perceived patient nonadherence and inadequate insurance coverage are cited as the primary barriers to AHM.
Conclusions: Despite broad US Food and Drug Administration approval for patients with symptoms and at increased risk for worsening heart failure, the adoption of pulmonary artery pressure monitoring is concentrated at advanced heart failure centers, and modest numbers of patients are implanted at most centers. Understanding and addressing the barriers to referral of eligible patients and to broader adoption in community heart failure programs is needed to maximize the clinical benefits of AHM.
Competing Interests: Declaration of Competing Interest AB is a consultant for Abbott. TAB is on the speaker's bureau for Abbott, KB is on the speaker's bureau for Abbott, Pfizer, and Novartis and a consultant for Abbott. AS has received research funding from Abbott, Edwards Lifesciences, Vifor, Pfizer, Bayer, General Prognostics, Story Health, Acorai, Boston Scientific, and Impulse Dynamics; is on the steering committees of Abbott, Boston Scientific, Biotronik, Story Health, RIVUS, Bayer, and General Prognostics; and is a consultant for Abbott, Boston Scientific, Edwards Lifesciences, Impulse Dynamics, Acorai, Story Health, General Prognostics, and BayerMF; TH has received research support from Abbott and Impedimed; and is a member of the speaker's bureau for Actelion Pharmaceuticals, Medtronic, Abbott, Boehringer Ingelheim, Bayer, and Lily. JA is a member of the speaker's bureau for Abbott and Abiomed; a consultant for Abbott and Abiomed; and a member of the steering committee for Abbott and Abiomed. The remaining authors declare no conflicts.
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