138 Physiological detection of clinical worsening and therapeutic response using implanted remote technologies in pah Article Swipe
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· 2023
· Open Access
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· DOI: https://doi.org/10.1136/heartjnl-2023-bcs.138
· OA: W4384568252
<h3>Introduction</h3> European guidelines for pulmonary hypertension (PH) recommend comprehensive risk stratification to optimise therapy and achieve/maintain a low risk profile (table 1) using repeated hospital-based investigations undertaken in specialist centres. Resting heart rate (RHR), total pulmonary resistance (TPR) and physical activity (min/day) are associated with mortality in patients with PAH and may be combined to provide a remote physiological risk score. In patients with implanted cardiac monitors and pulmonary artery pressure monitors we sought to observe the change in physiology following clinically indicated escalation of therapy and around the time of clinical worsening events. <h3>Methods</h3> 28 patients with pulmonary arterial hypertension (PAH) were enrolled into (NAIAD – 13/EE/0203) and FIT-PH (19/YH/0354) and implanted with a pulmonary artery pressure monitor (CardioMEMs, Abbott) and insertable cardiac monitors (ICM, LinQ, Medtronic) to measure daily physical activity, cardiac output, mean pulmonary artery pressure (mPAP), total pulmonary resistance (TPR), night heart rate and day heart rate. <h3>Results</h3> Following therapeutic escalation (n=18), remote mPAP, TPR, cardiac output and physical activity all improved at days 7, 4, 22 and 42 respectively (p<0.05) compared to control (n=28). Clinical worsening events (CWE, n=13) were preceded by an increase in remote monitored mPAP, TPR (figure 2) and reduction in cardiac output and physical activity (p<0.05) compared to the control group (n=24). Changes in physiological risk score (formula) were detectable 6 days after therapeutic escalation and 10 days prior to CWE (p<0.05). <h3>Conclusion</h3> Daily data provided by implanted, regulatory approved devices accurately provides an early evaluation of clinical efficacy and clinical worsening in patients with pulmonary arterial hypertension. Remote risk evaluation may facilitate personalised therapy and proactive management. Such data can be applied to a newly derived remote physiological risk score, and has valuable utility to clinical practice, and clinical trials. <h3>Conflict of Interest</h3> None
