How Earlier Hemodynamic Insight May Help Guide Heart Failure Management

Sponsored by Abbott 

Written by Dr. Sandip Zalawadiya, Medical Director of the Ventricular Assist Device Program and Director of Remote Patient Management Devices in Nashville, Tenn. 

Heart failure continues to place a significant burden on patients and the healthcare system, with nearly 7 million Americans living with heart failure, with prevalence expected to reach nearly 9 million by 2030. Despite advances in guideline-directed medical therapy (GDMT), many patients still face high risks of hospitalization, mortality, and reduced quality of life.¹

For these reasons, we ought to move beyond just guideline-directed medical therapy and device therapies and look for additional ways to help our patients. Remote patient monitoring, especially implantable pulmonary artery pressure sensors, can play an excellent role here, irrespective of ejection fraction. 

Why earlier insight matters: Pulmonary artery (PA) pressure monitoring can provide clinicians with earlier visibility into worsening heart failure and help guide treatment decisions. The first 90 days post-implantation can be particularly important, as several trends become apparent:²

• Most PA pressure reduction occurs within the first 90 days
• Most patient contacts and medication interventions also happen during that period

How hemodynamic monitoring supports patient management: With hemodynamic insights gathered over time, care teams can:

• Adjust therapy before symptoms worsen 
• Identify patients requiring additional intervention 
• Investigate drivers such as valve disease or arrhythmias 
• Escalate patients to advanced heart failure therapy evaluations when needed 

Expanding access to proactive management: Remote pulmonary artery pressure monitoring with the CardioMEMS^TM HF System gives clinicians greater visibility between visits, enabling a more proactive approach to care to reduce PA pressures.^6,8-10

As more clinicians incorporate hemodynamic monitoring into heart failure management, coverage expansion is helping improve access for appropriate patients.  

The nationwide coverage decision has helped tremendously with access to the technology, especially for eligible patients with Medicare Advantage plans. The success rate for approval of the technology has increased significantly, helping expand patient access to pulmonary artery pressure monitoring in clinical practice.

CardioMEMS HF System Indications, Safety & Warnings

References 

1. Fonarow G, Ahmad F, Ahmad T, et al. HF STATS 2025: Heart Failure Epidemiology and Outcomes Statistics An Updated 2025 Report from the Heart Failure Society of America. Journal of Cardiac Failure, 2025; 32, 439-498 
2. Zalawadiya S, Abraham J, Rathman L, et al. Early Reduction of Pulmonary Artery Pressures Is Associated With Improved Mortality Among Medicare Beneficiaries With Heart Failure. JACC Heart Fail. 2025;13(10):102589. doi:10.1016/j.jchf.2025.102589. 
3. Heywood JT, Zalawadiya S, Bourge RC, et al. Sustained reduction in pulmonary artery pressures and hospitalizations during 2 years of ambulatory monitoring. J Card Fail. 2023;29(1):56–66. 
4. Angermann C, et al. Pulmonary artery pressure-guided therapy in ambulatory patients with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). European Journal of Heart Failure. 2020. doi:10.1002/ejhf.1943. 
5. Lindenfeld J, Zile MR, Desai AS, et al. Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial. Lancet. 2021; 398(10304):991-1001. doi:10.1016/S0140- 6736(21)01754-2 
6. Lindenfeld, J, Costanzo, M, Zile, M. et al. Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2024 Feb, 83 (6) 682-694.
7. Gheorghiade, Mihai, Leonardo De Luca, Gregg C. Fonarow, Gerasimos Filippatos, Marco Metro, and Gary S. Francis. 2005. “Pathophysiologic Targets in the Early Phase of Acute Heart Failure Syndromes.” The American Journal of Cardiology 96 (6): 11-17. doi:amjcard.2005.07.016. 
8. Brugts JJ, Radhoe SP, Clephas PRD, et al. Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial [published correction appears in The Lancet.2023;401(10394):2112]. The Lancet.2023;401(10394):2113-2123. doi:10.1016/S0140-6736(23)00923-6.
9. Adams KF Jr, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first100,000cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J2005 Feb;149(2):209-16.
10. Zile MR, Abraham WT, Stevenson LW, et al. Relationship Between Remote, Ambulatory Pulmonary Artery Pressures, and All-Cause Mortality in Patients With Chronic Heart Failure. Circ Heart Fail. Published online April 14, 2025. doi:10.1161/CIRCHEARTFAILURE.124.012754.

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