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Ambulatory hemodynamics in patients with chronic heart failure: implications for volume management in elderly patients.

Invasive hemodynamic assessment of patients with chronic heart failure is helpful in managing severe congestive symptoms associated with acute volume exacerbations that lead to hospitalizations. Information useful in guiding medication changes targeting control of left ventricular filling pressures can be obtained from measurements in the right ventricle. With the advent of implantable devices designed to treat heart failure, the logical next development is an implanted device that incorporates sophisticated monitoring systems capable of continuous acquisition of hemodynamic information over a long-term period. An implantable hemodynamic monitoring system (Chronicle; Medtronic, Inc., Minneapolis, MN) is safe to implant and has a pressure sensor with proven long-term reliability. Using transtelephonic data transmission and Internet-based information systems, ambulatory hemodynamic monitoring may reduce the need for hospitalizations and overall health care utilization in patients with symptomatic heart failure. This approach may be especially helpful for elderly patients with chronic heart failure in whom overdiuresis or volume contraction may lead to gait instability and falls. Additionally, elderly patients with heart failure from primary diastolic dysfunction may have a very narrow therapeutic window of optimal volume that is difficult to assess by daily weights and physical examination alone. This hypothesis is currently being tested in a prospective randomized clinical trial.