SMART-HF: Structured Management Approach to Remote Treatment of Heart Failure Associated With Predictable Hemodynamic Improvements In A Community Remote Pulmonary Artery Pressure Monitoring Program

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Abstract Aims Responses to remote pulmonary artery pressure data vary across programs. We evaluated SMART-HF, a structured pulmonary artery diastolic pressure (PAD)-guided workflow, in a community heart failure cohort. Methods We retrospectively analyzed adults with heart failure and an implanted pulmonary artery pressure sensor managed with SMART-HF. Pulmonary artery diastolic pressure (PAD) was calculated from prespecified 14-day windows at baseline, 90 days, and 6 months. Two hemodynamic management performance indices (HMPI) were prespecified: the 6-Month Delta HMPI (PAD reduction >2 mmHg from baseline) and the 90-Day Target HMPI (PAD ≤20 mmHg at 90 days). Exploratory analyses evaluated patients with baseline PAD >20 mmHg. Results Of 37 patients, 36 had paired 90-day and 29 had paired 6-month windows. Mean PAD decreased from 18.3 ± 7.0 to 16.1 ± 6.3 mmHg at 90 days and from 18.8 ± 6.8 to 15.5 ± 5.8 mmHg at 6 months (both P < 0.001). The 90-Day Target HMPI was achieved in 26/36 (72.2%) and the 6-Month Delta HMPI in 19/29 (65.5%) [95% CI 45.7-82.1]. In the exploratory subgroup (baseline PAD >20 mmHg), mean PAD changes were −2.9 ± 3.6 mmHg at 90 days (n = 19; P = 0.002) and −4.9 ± 4.9 mmHg at 6 months (n = 15; P = 0.002). Conclusions SMART-HF was associated with improved ambulatory pulmonary artery diastolic pressure control at 90 days and 6 months. Exploratory subgroup findings support further evaluation in patients with elevated baseline pulmonary artery diastolic pressure.

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