The implantable hemodynamic monitoring system.

Theresa M. Wadas is a coordinator for the adult acute and continuing care nurse practitioner program at the University of Alabama at Birmingham, Birmingham, Ala. Heart failure is a clinical syndrome that affects 5 million persons in the United States and results in substantial morbidity and mortality. Despite advances in pharmacological management, 50% of patients with chronic heart failure will die within 5 years of the diagnosis. The progression of left ventricular dysfunction and severe symptomatic decompensation often requiring hospitalization remain essential features of the heart failure syndrome. Heart failure is responsible for 11 million visits to healthcare providers’ offices, causes or contributes to more than 3.5 million hospitalizations annually, and remains the leading cause of hospitalization for those 65 years or older. The estimated economic burden of heart failure is $20 billion to $40 billion per year. This amount includes the cost of care delivered by healthcare providers, expenses related to hospital and nursing home services, and the cost of medications, home healthcare, and other medical durables. Managing patients with heart failure requires an accurate clinical assessment of the patients’ hemodynamic status. Subtle changes in volume status or intracardiac filling pressures may affect functional status, hemodynamic status, ventricular performance, and survival. In particular, elevated filling pressures (ie, increased jugular venous pressure, central venous pressure, right and left atrial and ventricular pressures, and pulmonary artery pressure) may lead to neurohormonal activation, which acts as a compensatory mechanism to support a failing heart. Without appropriate interventions, persistent neurohormonal activation leads to worsening cardiac function and deleterious outcomes of advanced heart failure. In order to prevent progression of heart failure, patients require frequent physical examination and judicious monitoring of their hemodynamic status to optimize therapy. Unfortunately, patients with comThe Implantable Hemodynamic Monitoring System CoverArticle