Thursday, February 5, 2015

New Device Reduces CHF Readmissions

By: Barry K. Rayburn, MD, FACC with Cardiovascular Associates

Congestive heart failure (CHF) remains a prevalent and morbid condition, affecting millions of Americans and accounting for the largest number of hospitalizations under the Medicare program. With annual spending in excess of $30 billion, a great deal of attention has been paid to strategies that reduce rehospitalization.

Hospitalization and subsequent rehospitalization are often triggered by acute decompensation in previously stable heart failure patients. Often these episodes are initiated by either changes in patient behavior with medications or diet or the occurrence of comorbid conditions that upset the delicate balance often seen in heart failure patients. Strategies to reduce rehospitalization have long been focused on patient education regarding compliance with medications and diet, appropriate guideline-driven management by physicians and heart failure management programs that try to proactively identify problems before they result in hospitalization. These measures are variably successful and despite fairly wide implementation, heart failure admissions and readmissions continue to be problematic.

The CardioMEMS Heart Failure Management System has recently been approved by the FDA for use and physicians at Cardiovascular Associates of the Southeast have implanted this device in patients in an effort to reduce hospital admissions. The device consists of a small sensor (smaller than a dime) implanted in the pulmonary artery of a heart failure patient and a home monitoring unit. The patient lays on a pillow which activates the device and takes a recording of the patient’s pulmonary artery pressures (a very useful surrogate for volume status) and transmits the data to a secure website. By following trends over time, the system can reliably identify increasing problems early – often weeks in advance of the need for hospitalization – and allow for medication adjustment. In the CHAMPION Trial, patients with Class III heart failure and a prior hospitalization were shown to have a 37% reduction in rehospitalization when the device was used as part of their management program. The sensor is unique, having no internal power supply and therefore offering monitoring capabilities for prolonged periods. Implantation can be done as an outpatient procedure and monitoring requires only a few minutes each day. Clinicians can set thresholds based on individual patient needs and are notified by email if a patient exceeds preset thresholds. This device offers another tool in the ongoing fight to improve the lives of our patients with heart failure.

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