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, P R D Clephas Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic V W Zwartkruis Department of Cardiology, University Medical Centre Groningen , Groningen , Netherlands Search for other works by this author on: Oxford Academic J Malgie Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic M W F van Gent Department of Cardiology, Albert Schweitzer Hospital , Dordrecht , Netherlands Search for other works by this author on: Oxford Academic H P Brunner-La Rocca Department of Cardiology, Maastricht University Medical Centre , Maastricht , Netherlands Search for other works by this author on: Oxford Academic M K Szymanski Department of Cardiology, University Medical Center Utrecht , Utrecht , Netherlands Search for other works by this author on: Oxford Academic V P van Halm Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam , Amsterdam , Netherlands Search for other works by this author on: Oxford Academic M L Handoko Department of Cardiology, University Medical Center Utrecht , Utrecht , Netherlands Search for other works by this author on: Oxford Academic W Kok Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam , Amsterdam , Netherlands Search for other works by this author on: Oxford Academic F W Asselbergs Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam , Amsterdam , Netherlands Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0001-9752-6962 , R van Kimmenade Department of Cardiology, Radboud University Medical Centre , Nijmegen , Netherlands Search for other works by this author on: Oxford Academic O Manintveld Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic N M D A van Mieghem Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic S L M A Beeres Department of Cardiology, Leiden University Medical Centre , Leiden , Netherlands Search for other works by this author on: Oxford Academic M C Post Department of Cardiology, University Medical Center Utrecht , Utrecht , Netherlands Department of Cardiology, St. Antonius Hospital , Nieuwegein , Netherlands Search for other works by this author on: Oxford Academic C J W Borleffs Department of Cardiology, HAGA Hospital , Den Haag , Netherlands Search for other works by this author on: Oxford Academic R Tukkie Department of Cardiology, Spaarne Hospital , Haarlem , Netherlands Search for other works by this author on: Oxford Academic A Mosterd Department of Cardiology, Meander Medical Centre , Amersfoort , Netherlands Search for other works by this author on: Oxford Academic G C M Linssen Department of Cardiology, Hospital Group Twente , Almelo , Netherlands Search for other works by this author on: Oxford Academic R F Spee Department of Cardiology, Maxima Medical Centre , Veldhoven/Eindhoven , Netherlands Search for other works by this author on: Oxford Academic M E Emans Department of Cardiology, Ikazia hospital , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic T D J Smilde Department of Cardiology, Scheeper Hospital TREANT , Emmen , Netherlands Search for other works by this author on: Oxford Academic J van Ramshorst Department of Cardiology, Noordwest Hospital group , Alkmaar , Netherlands Search for other works by this author on: Oxford Academic C Kirchhof Department of Cardiology, Alrijne Hospital , Leiderdorp , Netherlands Search for other works by this author on: Oxford Academic F Feenema–Aardema Department of Cardiology, Medical Centre Leeuwarden , Leeuwarden , Netherlands Search for other works by this author on: Oxford Academic C A da Fonseca Department of Cardiology, Medical Centre Leeuwarden , Leeuwarden , Netherlands Search for other works by this author on: Oxford Academic M van den Heuve Department of Cardiology, Department of Cardiology, Medisch Spectrum Twente , Enschede , Netherlands Search for other works by this author on: Oxford Academic R Hazeleger Department of Cardiology, Vie Curi Hospital , Venlo , Netherlands Search for other works by this author on: Oxford Academic M van Eck Department of Cardiology, Jeroen Bosch Hospital, ’s-Hertogenbosch , Netherlands Search for other works by this author on: Oxford Academic L van Heerebeek Department of Cardiology, OLVG Hospital , Amsterdam , Netherlands Search for other works by this author on: Oxford Academic H Boersma Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic M Rienstra Department of Cardiology, University Medical Centre Groningen , Groningen , Netherlands Search for other works by this author on: Oxford Academic R A de Boer Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Search for other works by this author on: Oxford Academic J J Brugts Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center , Rotterdam , Netherlands Correspondence to: j.brugts@erasmusmc.nl Search for other works by this author on: Oxford Academic
V.W. Zwartkruis and J. Malgie shared second authorship
Author Notes
European Heart Journal, ehae323, https://doi.org/10.1093/eurheartj/ehae323
Published:
11 May 2024
Article history
Received:
08 April 2024
Revision received:
03 May 2024
Accepted:
09 May 2024
Published:
11 May 2024
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P R D Clephas, V W Zwartkruis, J Malgie, M W F van Gent, H P Brunner-La Rocca, M K Szymanski, V P van Halm, M L Handoko, W Kok, F W Asselbergs, R van Kimmenade, O Manintveld, N M D A van Mieghem, S L M A Beeres, M C Post, C J W Borleffs, R Tukkie, A Mosterd, G C M Linssen, R F Spee, M E Emans, T D J Smilde, J van Ramshorst, C Kirchhof, F Feenema–Aardema, C A da Fonseca, M van den Heuve, R Hazeleger, M van Eck, L van Heerebeek, H Boersma, M Rienstra, R A de Boer, J J Brugts, Pulmonary artery pressure monitoring in chronic heart failure: effects across clinically relevant subgroups in the MONITOR-HF trial, European Heart Journal, 2024;, ehae323, https://doi.org/10.1093/eurheartj/ehae323
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Abstract
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 resynchronisation 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 nonsignificant). In the unadjusted analysis of the primary endpoint quality-of-life change, weak trends towards a less pronounced effect in older patients (Pinteraction = 0.03; adjusted Pinteraction = 0.33) and diabetics (Pinteraction = 0.01; adjusted Pinteraction = 0.06) 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.
Structured Graphical Abstract
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Randomized controlled trial, pulmonary artery pressure, sensor, telemonitoring, subgroups, quality of life
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Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout.
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Author notes
V.W. Zwartkruis and J. Malgie shared second authorship
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Topic:
- chronic heart failure
- diabetes mellitus
- heart failure
- quality of life
- pulmonary artery pressure
- quality improvement
- surrogate endpoints
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