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Use of a Continuous Hemodynamic Monitoring Sensor to Assist with Patient Compliance of PAH Medications

Kimberley Litton

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Conference: 2015 PH Professional Network Symposium

Release Date: 09.17.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1015

File Size: (241 kb)

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Purpose

Patients with pulmonary arterial hypertension need to be compliant with their medication dosing in order to obtain the maximum benefit of the medications. Having a way to continuously monitor the patient’s pulmonary artery pressures on a daily basis and “virtually visualize” the patients response to their medication will help identify compliance of patients, decrease the number of hospitalizations and allow the clinician to modulate PAH therapy on a day-to-day basis.

Background

The CardioMEMS system, developed by St. Jude Medical, is a small wireless sensor, implanted into the patient’s distal pulmonary artery. This small sensor provides continuous pulmonary artery hemodynamic data used for monitoring and managing the patients. The CardioMEMS sensor is implanted in the pulmonary artery system and once implanted can provide the following data: PA pressure waveform; systolic, diastolic and mean PA pressure; and heart rate. Patients with PAH and on IV, SQ or inhalation therapies can be continually monitored and their medications adjusted according to patient response as well as their PA pressures. As a patient responds to the medication their PA pressures should respond accordingly. Continuous monitoring of the PA pressures of a patient can help the clinician recognize patients who are compliant and/or not compliant with medication regime and help direct the course of treatment.

Methods

Several patients have been enrolled in the VITA study at our institution. The patients’ PA pressures and waveforms are continuously monitored. This is done a minimum of four times per week. Any increase in the PA pressure waveform is monitored and the patient called and meds adjusted as necessary. From this population of patients at our institution, we have chosen three patients. Two of the patients have been very compliant on their PAH therapies and their PA pressure and clinical response is reflected in the decrease and downward trends noted in the PA pressure graphs. One of the three patients has not been compliant and every time she goes off PAH therapy her PA pressures rise and she has more negative clinical symptomology, which is reflected in an upward trend in the PA graphs.

Results

The patients’ PA pressures and waveforms are continuously monitored. This is done a minimum of three times per week. Any increase in the PA pressure waveform is monitored and the patient called and meds adjusted as necessary. This continuous monitoring of the PA pressures and waveforms had led to a decrease in the patient hospitalization, better compliance and adherence to medicine regime and day-to-day PAH therapy modulation.

Conclusion

Although PAH remains a challenging disease to diagnose and manage, a better understanding of the patient’s direct and immediate response to the medications helps in the advancement of better and more efficient treatment. The continuous monitoring of the patient’s PA pressures allows the clinician to observe on a day-to-day basis the patient’s clinical and physiological response to medicine. Further research is necessary to determine the greatest benefit and use of the wireless PA sensor device.