The following is a summary of “Hemodynamically-Guided Management of Heart Failure Across the Ejection Fraction Spectrum: The GUIDE-HF Trial” published in the December 2022 issue of Heart Failure by R. Zile MD et al.

The reduction of heart failure (HF) hospitalizations in patients with New York Heart Association (NYHA) functional class II-III and history of HF hospitalization or elevated natriuretic peptides can be achieved through hemodynamically guided management using an implanted pulmonary artery pressure sensor. In the GUIDE-HF (Hemodynamic-GUIDEd management of Heart Failure) randomized study, the authors aimed to assess the impact of left ventricular ejection fraction (EF) on treatment results. A total of 1,000 patients in New York Heart Association (NYHA) functional classes II–IV (with HF hospitalization within the previous 12 months or elevated natriuretic peptides adjusted for EF and body mass index) were enrolled in the GUIDE-HF randomized arm and randomly assigned to either a hemodynamically guided management group (treatment) or a control group  (control). 

Hospitalizations for heart failure (HF), emergency room visits for HF, and death from any cause throughout the study period were considered the primary endpoint. Within the trial-specified pre-COVID-19 era cohort, the authors analyzed outcomes by EF in guideline-defined subgroups of≤ 40%, 41%-49%, and ≥50%. Hospitalization for HF was less common in the treatment group than in the control group (HR: 0.72 [95% CI: 0.57-0.92]; P=0.0072), and there were 177 primary events (0.553/patient-year) in the treatment group compared to 224 occurrences (0.682/patient-year) in the control group.

Lower incidences of the main endpoint and HF hospitalization were seen in the therapy group across the board for each EF subgroup (HR<1.0). Reduction in pulmonary artery pressures and medication modifications were associated with a lower event rate measured by EF in the therapy groups. Patients with a wider range of EF benefit from reduced HF-related outcomes with a hemodynamically guided approach to HF therapy. NCT03387813 Hemodynamic-GUIDEd Management of Heart Failure.