Retrospective Evaluation Of Suspected Vs. Confirmed Transthyretin Amyloid Cardiomyopathy (ATTR-CM) Cases
HFSA ePoster Library. Akers T. 09/10/21; 343520; 283
Taylor Akers
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Abstract
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Introduction: Use of implantable pulmonary artery pressure monitoring in select patients with heart failure (HF) has been associated with reduction in HF-related admissions and improved HF-specific health status. We sought to analyze real world data from a large tertiary referral center after three years of implants, to inform future patient selection and management.
Methods: Using retrospective chart abstraction, we collected data on baseline demographics and outcomes of interest for all patients implanted from 1/1/2017 through 12/31/2019 at a single center. Using paired t-tests, we compared frequency of relevant health system encounters in the year before and the year after implant.
Results: The study cohort (n=63) was comprised of 33% (n=21) females, mean (±SD) age of 72.7 (±10.7) yrs, 49% HFpEF (EF>50%; n=31), 5% HFmrEF (EF=40-50%; n=3), and 46% HFrEF (EF<40%, n=29). Mean (±SD) eGFR at implant was 45.7 (±16.9) ml/min: 16% CKD Stage 2 (eGFR 60-89 ml/min; n=10), 71% Stage 3 (eGFR 30-59 ml/min; n=45), and 13% Stage 4 (eGFR 15-30 ml/min; n=8). HF readmission within 30 dys after implant occurred in 8% of patients (n=5). In comparison of the year before vs the year after implant, patients experienced significant reductions in the frequency of nearly all health system encounters. (Table) In the first year post-implant, 3% of patients (n=2) underwent LVAD implant, 3% (n=2) had progression of CKD requiring initiation of dialysis, 8% (n=5) required device recalibration due to discordant pressure readings, and 20% (n=13) did not survive to one year post-implant. In sensitivity analysis with these 13 patients removed, results remained similar. Among the subset of patients with no HF ED visits/admissions in the year before implant who lived at least one year post-implant (n=11), frequency of HF clinic visits decreased significantly (mean [±SD] visits pre = 6.1 [±3.0] vs post = 2.6 [±1.4]; p=0.0054).
Conclusion: In this three-year, single-center experience using implantable pulmonary artery pressure monitoring to guide treatment of patients with HF, the study population experienced significant reductions in encounters with the health system, even in the absence of HF admissions in the year before implant, and despite event rates in the year post-implant implying a high acuity, highly morbid population.
Methods: Using retrospective chart abstraction, we collected data on baseline demographics and outcomes of interest for all patients implanted from 1/1/2017 through 12/31/2019 at a single center. Using paired t-tests, we compared frequency of relevant health system encounters in the year before and the year after implant.
Results: The study cohort (n=63) was comprised of 33% (n=21) females, mean (±SD) age of 72.7 (±10.7) yrs, 49% HFpEF (EF>50%; n=31), 5% HFmrEF (EF=40-50%; n=3), and 46% HFrEF (EF<40%, n=29). Mean (±SD) eGFR at implant was 45.7 (±16.9) ml/min: 16% CKD Stage 2 (eGFR 60-89 ml/min; n=10), 71% Stage 3 (eGFR 30-59 ml/min; n=45), and 13% Stage 4 (eGFR 15-30 ml/min; n=8). HF readmission within 30 dys after implant occurred in 8% of patients (n=5). In comparison of the year before vs the year after implant, patients experienced significant reductions in the frequency of nearly all health system encounters. (Table) In the first year post-implant, 3% of patients (n=2) underwent LVAD implant, 3% (n=2) had progression of CKD requiring initiation of dialysis, 8% (n=5) required device recalibration due to discordant pressure readings, and 20% (n=13) did not survive to one year post-implant. In sensitivity analysis with these 13 patients removed, results remained similar. Among the subset of patients with no HF ED visits/admissions in the year before implant who lived at least one year post-implant (n=11), frequency of HF clinic visits decreased significantly (mean [±SD] visits pre = 6.1 [±3.0] vs post = 2.6 [±1.4]; p=0.0054).
Conclusion: In this three-year, single-center experience using implantable pulmonary artery pressure monitoring to guide treatment of patients with HF, the study population experienced significant reductions in encounters with the health system, even in the absence of HF admissions in the year before implant, and despite event rates in the year post-implant implying a high acuity, highly morbid population.
Introduction: Use of implantable pulmonary artery pressure monitoring in select patients with heart failure (HF) has been associated with reduction in HF-related admissions and improved HF-specific health status. We sought to analyze real world data from a large tertiary referral center after three years of implants, to inform future patient selection and management.
Methods: Using retrospective chart abstraction, we collected data on baseline demographics and outcomes of interest for all patients implanted from 1/1/2017 through 12/31/2019 at a single center. Using paired t-tests, we compared frequency of relevant health system encounters in the year before and the year after implant.
Results: The study cohort (n=63) was comprised of 33% (n=21) females, mean (±SD) age of 72.7 (±10.7) yrs, 49% HFpEF (EF>50%; n=31), 5% HFmrEF (EF=40-50%; n=3), and 46% HFrEF (EF<40%, n=29). Mean (±SD) eGFR at implant was 45.7 (±16.9) ml/min: 16% CKD Stage 2 (eGFR 60-89 ml/min; n=10), 71% Stage 3 (eGFR 30-59 ml/min; n=45), and 13% Stage 4 (eGFR 15-30 ml/min; n=8). HF readmission within 30 dys after implant occurred in 8% of patients (n=5). In comparison of the year before vs the year after implant, patients experienced significant reductions in the frequency of nearly all health system encounters. (Table) In the first year post-implant, 3% of patients (n=2) underwent LVAD implant, 3% (n=2) had progression of CKD requiring initiation of dialysis, 8% (n=5) required device recalibration due to discordant pressure readings, and 20% (n=13) did not survive to one year post-implant. In sensitivity analysis with these 13 patients removed, results remained similar. Among the subset of patients with no HF ED visits/admissions in the year before implant who lived at least one year post-implant (n=11), frequency of HF clinic visits decreased significantly (mean [±SD] visits pre = 6.1 [±3.0] vs post = 2.6 [±1.4]; p=0.0054).
Conclusion: In this three-year, single-center experience using implantable pulmonary artery pressure monitoring to guide treatment of patients with HF, the study population experienced significant reductions in encounters with the health system, even in the absence of HF admissions in the year before implant, and despite event rates in the year post-implant implying a high acuity, highly morbid population.
Methods: Using retrospective chart abstraction, we collected data on baseline demographics and outcomes of interest for all patients implanted from 1/1/2017 through 12/31/2019 at a single center. Using paired t-tests, we compared frequency of relevant health system encounters in the year before and the year after implant.
Results: The study cohort (n=63) was comprised of 33% (n=21) females, mean (±SD) age of 72.7 (±10.7) yrs, 49% HFpEF (EF>50%; n=31), 5% HFmrEF (EF=40-50%; n=3), and 46% HFrEF (EF<40%, n=29). Mean (±SD) eGFR at implant was 45.7 (±16.9) ml/min: 16% CKD Stage 2 (eGFR 60-89 ml/min; n=10), 71% Stage 3 (eGFR 30-59 ml/min; n=45), and 13% Stage 4 (eGFR 15-30 ml/min; n=8). HF readmission within 30 dys after implant occurred in 8% of patients (n=5). In comparison of the year before vs the year after implant, patients experienced significant reductions in the frequency of nearly all health system encounters. (Table) In the first year post-implant, 3% of patients (n=2) underwent LVAD implant, 3% (n=2) had progression of CKD requiring initiation of dialysis, 8% (n=5) required device recalibration due to discordant pressure readings, and 20% (n=13) did not survive to one year post-implant. In sensitivity analysis with these 13 patients removed, results remained similar. Among the subset of patients with no HF ED visits/admissions in the year before implant who lived at least one year post-implant (n=11), frequency of HF clinic visits decreased significantly (mean [±SD] visits pre = 6.1 [±3.0] vs post = 2.6 [±1.4]; p=0.0054).
Conclusion: In this three-year, single-center experience using implantable pulmonary artery pressure monitoring to guide treatment of patients with HF, the study population experienced significant reductions in encounters with the health system, even in the absence of HF admissions in the year before implant, and despite event rates in the year post-implant implying a high acuity, highly morbid population.
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