Remote Pulmonary Artery Pressure-Guided Management of Patients with Heart Failure: A Clinical Consensus Statement of the Heart Failure Association (HFA) of the ESC

Episodes of worsening heart failure (HF) are a major cause of unplanned hospitalizations. Their onset is usually preceded by an early increase in intracardiac pressures with subsequent worsening of symptoms due to congestion. Implantable devices allowing daily remote pulmonary artery pressure (PAP) monitoring are useful to identify early haemodynamic changes so that medical therapy can be adjusted at an early stage, before symptom onset, and HF-related hospitalizations be prevented. Second, the use of these devices may help to maintain clinical stability keeping PAP in the target range on a day-to-day basis. The CardioMEMS system allows remote PAP monitoring, and PAP-guided medical therapy has reduced HF-related hospitalizations in prospective, randomized, controlled clinical trials in symptomatic patients with HF, independent of their left ventricular ejection fraction. The safety and feasibility of other devices, like the Cordella implantable PAP sensor, have also been demonstrated and clinical usefulness in larger patient populations is currently being assessed in several trials. Most of the studies testing remote PAP monitoring were reported after the 2021 European Society of Cardiology HF guidelines. An update of the clinical significance and potential implications for clinical practice of these systems seems therefore warranted. The aim of this clinical consensus statement is to summarize current knowledge on remote PAP-guided management of patients with HF, with a special focus on current evidence from clinical trials, potential impact on clinical practice and management aspects.