Exploration of seated-supine difference as a phenotyping tool and monitoring metric in remotely monitored heart failure patients
M Fudim, J L Guichard, S K Zalawadiya, R J Tedford, T Alexy, L KleinAbstract
Background
The Cordella Pulmonary Artery Pressure (PAP) Sensor can measure both seated and supine PAP to guide heart failure (HF) management. The relationship between seated and supine mean PAP (mPAP) may provide additional information on disease phenotype and inform intervention strategies.
Methods
Patients in the PROACTIVE-HF trial were assessed for supine-seated delta (SSΔ) at baseline and divided into SSΔ quartiles groups (indicated as Q1 to Q4 herein), with Q1 patients having the lowest SSΔ (<4.7) and Q4 having the highest (>13.2). SSΔ groups were compared on a variety of key baseline characteristics including age, sex, mPAP, ejection fraction (EF) classification, and HF history prior to study initiation. Additionally, 24-month incidence rates of HF events (HFEs; a HF hospitalization, emergency room, or urgent care visit) and treatment-related events (TREs; kidney injury or hypotension event deemed to be related to HF treatment) were compared between quartiles. We also compared SSΔ in the 30d prior to an HFE or TRE to baseline SSΔ.
Results
Patients in Q4 had higher percentage of HF with preserved EF (HFpEF) than those in Q1 (50.9% vs 34%, p=0.005) but were not significantly different on any other key baseline characteristics, including mPAP at baseline (28.8±9.9 vs 28.4±11.7). There was no significant difference in HFE 24-month incidence rates between Q1 and Q4 (p=0.51), but Q4 patients had a higher 24-month incidence of TREs than Q1 patients (0.28[CI: 0.19-.4] vs 0.1[CI:0.06-0.19], p<0.001). In general, SSΔ decreased from baseline immediately prior to HFE (9.4±5.9 vs 6.7±5.2, p<0.001, n=97) or TRE (12.7±11.3 vs 4.8±6.8, p=0.003, n=19). There was a mean of 9.2±5.9d and 8.2±7.7d between SSΔ reading and HFE/TRE, respectively.
Conclusion
Patients with high SSΔ at baseline were at increased risk of TREs through 24m despite similar baseline seated mPAP, and patient SSΔ decreased before both HFEs and TREs compared to baseline. The postural response in HF patients may reflect key aspects of congestion physiology.For image description, please refer to the figure legend and surrounding text.