Cited 4 times since 2024 (4.7 per year) source: EuropePMC European heart journal, Volume 45, Issue 32, 1 1 2024, Pages 2954-2964 Pulmonary artery pressure monitoring in chronic heart failure: effects across clinically relevant subgroups in the MONITOR-HF trial. Clephas PRD, Zwartkruis VW, Malgie J, van Gent MWF, Brunner-La Rocca HP, Szymanski MK, van Halm VP, Handoko ML, Kok WEM, Asselbergs FW, van Kimmenade RRJ, Manintveld OC, van Mieghem NMDA, Beeres SLMA, Post MC, Borleffs CJW, Tukkie R, Mosterd A, Linssen GCM, Spee RF, Emans ME, Smilde TDJ, van Ramshorst J, Kirchhof CJHJ, Feenema-Aardema MW, da Fonseca CA, van den Heuvel M, Hazeleger R, van Eck M, van Heerebeek L, Boersma E, Rienstra M, de Boer RA, Brugts JJ
Background and aims
In patients with chronic heart failure (HF), the MONITOR-HF trial demonstrated the efficacy of pulmonary artery (PA)-guided HF therapy over standard of care in improving quality of life and reducing HF hospitalizations and mean PA pressure. This study aimed to evaluate the consistency of these benefits in relation to clinically relevant subgroups.
Methods
The effect of PA-guided HF therapy was evaluated in the MONITOR-HF trial among predefined subgroups based on age, sex, atrial fibrillation, diabetes mellitus, left ventricular ejection fraction, HF aetiology, cardiac resynchronization therapy, and implantable cardioverter defibrillator. Outcome measures were based upon significance in the main trial and included quality of life-, clinical-, and PA pressure endpoints, and were assessed for each subgroup. Differential effects in relation to the subgroups were assessed with interaction terms. Both unadjusted and multiple testing adjusted interaction terms were presented.
Results
The effects of PA monitoring on quality of life, clinical events, and PA pressure were consistent in the predefined subgroups, without any clinically relevant heterogeneity within or across all endpoint categories (all adjusted interaction P-values were non-significant). In the unadjusted analysis of the primary endpoint quality-of-life change, weak trends towards a less pronounced effect in older patients (Pinteraction = .03; adjusted Pinteraction = .33) and diabetics (Pinteraction = .01; adjusted Pinteraction = .06) were observed. However, these interaction effects did not persist after adjusting for multiple testing.
Conclusions
This subgroup analysis confirmed the consistent benefits of PA-guided HF therapy observed in the MONITOR-HF trial across clinically relevant subgroups, highlighting its efficacy in improving quality of life, clinical, and PA pressure endpoints in chronic HF patients.
