Percutaneous implantation of pulmonary artery pressure sensors for monitoring treatment of chronic heart failure

Evidence-based recommendations on percutaneous implantation of pulmonary artery pressure sensors for monitoring treatment of chronic heart failure in adults. This involves putting a small electronic pressure sensor into the pulmonary artery to measure blood pressure.

# Recommendations
Evidence on the safety and efficacy of percutaneous implantation of pulmonary artery pressure sensors for monitoring treatment of chronic heart failure is adequate to support using this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
Patient selection, continuing monitoring and management should be done by a multidisciplinary team. This should include healthcare professionals (both a doctor and a nurse) experienced in managing chronic heart failure, and interventional specialists experienced in right-heart catheterisation and inserting this device.# The condition, current treatments and procedure

# The condition
Heart failure happens when the pumping action of the heart is impaired by structural or functional abnormalities. It can lead to reduced blood flow to the body tissues and increased filling pressure in the heart. This causes congestion and oedema in the lungs (causing breathlessness) and the body (causing swelling in the legs). Symptoms include breathlessness, reduced exercise tolerance, oedema, fatigue and malaise.

# Current treatments
Diagnosis and management of chronic heart failure is described in NICE's guideline on chronic heart failure in adults. Treatments include lifestyle changes, medicines, device implantation (to help control heart rhythm) and heart surgery (such as a bypass operation or a heart transplant).
Chronic heart failure needs regular monitoring to identify signs of deterioration and modify treatment, with the aim of improving the patient's quality of life and avoiding hospital admissions. Monitoring includes assessment of functional capacity, fluid status, blood pressure, cardiac rhythm, renal function, and cognitive and nutritional status. Medication is reviewed and adjusted if necessary. Implantable devices to monitor haemodynamic changes may assist heart failure monitoring.

# The procedure
A delivery catheter is introduced into a large vein (usually the femoral vein) under local anaesthesia. Under radiological guidance, the catheter is used to pass a small pressure sensor through the heart and into a suitable branch of the pulmonary artery. The pressure sensor is deployed and the delivery catheter removed. Data on pulmonary artery pressure (PAP), such as pressure trend information and PAP waveforms, is transmitted from the sensor to an external monitor in the patient's home. The monitor securely transmits the data to a remote database that can be accessed by the heart failure team. The patient usually collects and transmits data daily, or more often if needed by the heart failure team.
This procedure makes data available that can be used to guide the ongoing monitoring and management of chronic heart failure. The aim is to reduce hospitalisations caused by heart failure.