Congestion remains a key driver of heart failure (HF) progression and decompensation, yet standardized management approaches are limited. A pooled analysis of two prospective studies (FUTURE-HF and FUTURE-HFII), published in the European Journal of Heart Failure, evaluated 12-month outcomes following implantation of an inferior vena cava (IVC) sensor for congestion monitoring in patients with heart failure.

The cohort included 65 patients (mean age 65.7±9.5 years), predominantly New York Heart Association (NYHA) Class III (75.4%) and with heart failure with reduced ejection fraction (HFrEF) (90.8%). Patients performed daily IVC parameter recordings. Outcomes assessed included adjudicated safety, agreement between sensor-derived IVC area and computed tomography (CT), treatment adjustments, and clinical endpoints.

No adjudicated device- or procedure-related serious adverse events occurred. Strong agreement between sensor-derived and CT-derived IVC area was demonstrated (n=44; R²=0.97; mean relative error <5%). Adherence to daily monitoring was high (93%). A sustained reduction in IVC area (8.1%, p<0.005) was observed and correlated with improvements in clinical status (p<0.001), without significant change in body weight. 

Functional status improved, with NYHA Class III decreasing from 74.5% to 40.0% (p<0.01), alongside reductions in NT-proBNP (median 1697 to 998 ng/L; p<0.001). HF events (HFEs)  decreased from 1.67 to 0.31 events/year (84.5% relative reduction; rate ratio 0.18; 95% CI 0.08–0.29). A total of 415 medication adjustments were recorded, including diuretic titration (57%) and increased use of guideline-directed medical therapy (28%).

These findings indicate feasibility and sustained performance of ambulatory IVC monitoring. Larger randomized trials are needed to confirm whether congestion-guided management using IVC monitoring improves clinical outcomes.