Lindenfeld J, Zile MR, Desai AS, et al. - In heart failure patients, hemodynamic-guided management failed to decrease composite endpoint rate of mortality and total heart failure events relative to the control group in the overall study analysis but a likely advantage of this treatment strategy on the primary outcome was seen in the pre-COVID-19 period, mainly driven by a lower heart failure hospitalization rate than the control group.

• A total of 1,022 heart failure patients with all ejection fractions (NYHA funational class II–IV) and either a recent heart failure hospitalization or increased natriuretic peptides were enrolled.

• Post-successful implantation of a pulmonary artery pressure monitor, patients were randomized (1:1) to either hemodynamic-guided heart failure management based on pulmonary artery pressure or a usual care control group.

• In the hemodynamic-guided management group (treatment group), 253 primary endpoint events (a composite of all-cause death and total heart failure events at 12 months) (0·563 per patient-year) occurred in 497 patients; and 289 (0·640 per patient-year) in 503 patients in the control group (hazard ratio 0·88).

• Hemodynamic-guided management significantly reduced cumulative incidence of heart failure events in the pre-COVID-19 impact analysis.

• Freedom from device or system-related complications was seen in 1,014 (99%) of 1,022 patients.