Table 6.4. Ambulatory monitoring of congestion in heart failure.

Recommendations	Class	LE	Comments	Table 2018	Ref.
Invasive remote monitoring of congestion using an implantable, wireless pulmonary artery pressure sensor to reduce hospitalizations and mortality in outpatient HFrEF patients.	IIa	B	NEW: The current recommendation reflects data from small randomized trials and real-world studies, with impact in reducing hospitalizations and mortality.	New	30,53–57
While there has been relatively little innovation in the management of congestion in advanced HF, recent evidence suggests a potential benefit of remote monitoring, impacting the prognosis for HF patients. Studies of non-invasive home telemonitoring have shown improvements in hospital length of stay and all-cause mortality.30 Similar results were observed with the implantable CardioMEMS™ HF System, which provides direct pulmonary artery pressure monitoring. The impact of invasive monitoring was tested in the CHAMPION (Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial) trial, which involved outpatients with HF (FC III, NYHA) and demonstrated a 28% reduction in hospitalizations for HF. Among patients receiving at least two medications from standard HF therapy, invasive monitoring was associated with a 57% reduction in mortality.53 The CardioMEMS™ proved to be safe and effective in “real-world”, 54 as well as in cost-effectiveness studies.55 The data were recently replicated in a study conducted by multiple European centers56 and in an open multicenter prospective study of 1200 FC III patients, which found a significant decrease in hospitalizations for HF with low rates of complications associated with the implantable monitor over the one-year follow-up period.57 This is a promising strategy, with potential to be translated into clinical practice.

FC: functional class; HF: heart failure; NYHA: New York Heart Association; PAP: pulmonary artery pressure.