New diagnostic tool for congestive heart failure promises great improvement in treatment
Congestive heart failure (CHF) is one of the most difficult conditions to treat, and also the most expensive medical diagnosis resulting in the highest costs to Medicare in the United States. The American Heart Association estimates there are $31 billion in annual direct and indirect costs in the U.S.
At the current rate, treatment costs are expected to double by 2030.
“If we don’t rein this in, the average cost per taxpayer could be$244 per year in 2030,” said Stephanie Spencer RN, BSN, CHFN, the CHF clinical coordinator at the Arkansas Heart Hospital Clinic (AHHC), Little Rock.
About 25 percent of all heart failure admissions will be back in the hospital within 30 days. That is because the disease is so difficult to manage.
In mid-November, a new device called CardioMEMS HF System that promises to help better manage fluid status in heart failure patients was implanted into the first patient in Arkansas. Wilson Wong, MD, did the procedure at Arkansas Heart Hospital.
Clinical trials indicated CardioMEMS reduced hospital readmissions by 37 percent. CardioMEMS consists of an implantable pulmonary artery (PA) sensor, a delivery system, and Patient Electronics System. The sensor about the size of a paper clip has a thin, curved wire at each end, and requires no batteries or wires. It is implanted during a right heart catheterization procedure for permanent placement. The delivery system is a long, thin, flexible catheter that moves through the blood vessels and is designed to release the implantable sensor in the far end of the PA.
Spencer said by monitoring the PA pressure and heart rate in NYHA Class III heart failure patients, the tool gives clinicians valuable objective information about the fluid load in the heart.
“This is a most important tool that can help us address the readmission rate,” Spencer said. “Without a tool like this, we must rely on the patient’s ability to or compliance with weighing themselves every day, or calling us if they feel bad. Patients can swing back and forth from having fluid overload to being dehydrated. Sometimes patients don’t know if they are overloaded or not. They will call and say they just don’t feel good. They might have other issues like pneumonia or pleural effusions. This device lets us know if it is heart failure or not, and how to treat it more effectively. It gives us objective data about how to treat a patient.”
With the Affordable Care Act (ACA), hospitals can receive penalties of up to three percent of Medicare revenue if they fail to keep within the bounds of national 30-day readmission rates for CHF, which now is at 23 percent.
“The ACA shifted the focus to quality control instead of volume management,” she said.
The device is revolutionary, said Michael Huber, MD, director of the AHHC CHF Clinic.
“This is an early warning system,” Huber said. “It will revolutionize the way we manage heart failure patients. We can catch them before they get so bad they have to go into the hospital. It can give us the earliest indication heart failure is starting to go in a bad direction. Class three heart failure patients are having symptoms like shortness of breath every day just doing what they need to do to live a life. These patients are hard to manage because even when they do all they can like watching their weight and their diet, they often wind up coming back into the hospital because they can’t get it right.”
These are the most labor-intensive patients in a medical practice, Huber said, and this device can help simplify their assessment.
Indications for the device call for the patient being diagnosed with stage three CHF and one hospitalization for CHF in the past 12 months.
Implantation is pretty simple through the groin. Huber said once the device is put in, the patient can take readings at home by using land line or cellular connections to send a few minutes of pulmonary pressure readings to the website. When clinicians see that heart failure is getting worse, more diuretics or other heart failure medications can be introduced.
“Initially patients take readings once a day, but once they are stable, readings can be taken once a week,” Huber said. “CardioMEMS helps our team keep heart failure patients out of the hospital and allow them to have a meaningful and good quality of life.”
The clinic sees patients from all over the state.
“We manage large numbers of patients,” Spencer said. “A lot of my patients can’t make it to Little Rock. It is really burdensome for them to get to me. With this device, we have the potential to manage patients farther away by coordinating patient lab results with family doctor visits.”
Spencer said it is really exciting to see the potential outcomes from using this tool that can save lives, including decreased costs to taxpayers and better health for patients.
“Each time heart failure patients go into the hospital, their prognosis worsens,” she said. “We know if they are going into the hospital over and over, they will not do well. On average if a CHF patient has four hospitalizations in a year, that gives them a mean survival rate of only six months. If we are able to better manage them with this device and keep them out of the hospital, their prognosis would ostensibly improve.”
For more, visit: www.arheart.com
Photo notes: Mugshots of each source. Photo of two sources together: Stephanie Spencer RN, BSN, CHFN Arkansas Heart Hospital Clinic (AHHC) Congestive Heart Failure (CHF) Clinical Coordinator and Michael Huber, MD, Medical Director of AHHC CHF Clinic, believe that the new CardioMEMS system will improve their ability to treat patients, resulting in fewer hospital readmissions and far lower costs. Photos of CardioMEMS device.
Meta tags: CardioMEMS HF System, Arkansas Heart Hospital, Michael Huber, MD, Stephanie Spencer RN, Wilson Wong, MD, congestive heart failure, hospital readmission rates, Medicare, Affordable Care Act, Becky Gillette
