Does Hemodynamic-Guided Heart Failure Management Reduce Hospitalization? A Systematic Review

Heart failure (HF) is a pressing health concern as the expense of hospitalization financially burdens the health care system. Hemodynamic monitoring has the potential to detect increases in intracardiac filling pressures weeks before clinical deterioration; hence, preliminary findings of volume overload with the use of these devices may prevent the progression of disease and lead to a reduction in HF-associated hospitalizations. We extensively searched PubMed, Ovid SP, Embase, and Cochrane databases to identify all the possible studies that assess the effect of hemodynamic monitoring on hospitalizations in HF patients. The main outcomes considered were the rate of HF hospitalization, mortality, quality of life, and improvement in New York Heart Association (NYHA) functional class in the monitored group. Seven studies met all the eligibility criteria and were incorporated in our systematic review. Out of the seven studies we reviewed, three studies inserted the sensor in the pulmonary artery, three in the right ventricle, and only one in the left atrium. On an average, the single study on the left atrium showed the highest reduction (59.0%) in HF hospitalization followed by the pulmonary artery (56.3%) and right ventricle (31.0%), respectively. Our systematic review demonstrates that the use of hemodynamic sensors in HF patients helps to reduce HF-related hospitalizations. Therefore, a combination of outpatient monitoring via the use of hemodynamic sensors and fluid management is needed to reduce HF hospitalizations and improve outcomes in HF patients.