Mechanical Devices Buy Quality Time for Patients with Advanced Heart Disease

By Jennifer Lynn Cook, MD

The burden of heart failure is enormous in the United States. About 550,000 patients receive a new diagnosis every year, including 70,000 patients who are categorized as stage 4 or end-stage heart failure. The cost of care is estimated to be more than $10 billion per year.

Following a diagnosis of heart failure, the average survival is sobering – about 1.7 years for men and 3.7 years for women.

The focus of care in advanced heart failure is improving survival, but also quality of life.  Each patient defines quality of life in their own way, as typical heart failure symptoms include difficulty breathing, walking and participating in normal activities. 

Medication is the first line of treatment, but when this fails, patients are often considered for heart transplant, the gold standard for treating end-stage heart failure. One of the most rewarding aspects of my job is to see patients live their lives after heart transplant. They tell me that they’ve seen their grandchildren get married or they’ve taken the trip of their dreams. That’s very rewarding.

However, barriers, such as the shortage of donor organs, require heart-failure specialists to seek creative solutions. That’s where my field of expertise comes in and technology can help many patients not just live longer, but live better.

Steps to Smooth the Path: Online Check-up

Admission to the hospital is common for heart failure patients. After a hospital admission, the risk of death increases and quality of life decreases. To counter this, a clinical research study is underway at five Banner hospitals to reduce hospital admissions and improve quality of life. Patients now have access to an implantable hemodynamic monitoring system called CardioMEMs that measures blood pressure in the lungs. The entire device is about four inches wide - two wires that form a loop around a chip – and is implanted through the veins. From their home patients can record heart pressure measurements by simply lying down on a pillow for 17 seconds. The information is sent electronically and can be viewed by their doctor online.

In a recent CardioMEMS clinical trial, the device reduced hospital admissions by 37 percent. In our study, we will follow patients for two years to evaluate pulmonary arterial pressure plus functional capacity related to quality of life, such as how far can a patient walk.

Other Tools: Mechanical Circulatory Support Devices

In our advanced heart failure program, we have a variety of devices and procedures to match an individual patient’s unique needs. These include:

  • Minimally invasive cath-lab procedures for high-risk patients who need coronary artery interventions, such as a heart pump to improve blood flow.
  • Mechanical circulatory assist devices as a bridge to transplantation. These include heart pumps, ventricular assist devices when one side of heart is failing, or a total artificial heart when both sides of the heart are failing.
  • Mechanical circulatory assist devices as “destination therapy” for patients ineligible for transplant. This means the person will be on the device permanently.

It Takes a Team

The Advanced Heart Disease Team at UA Sarver Heart Center and Banner - University Medical Center Tucson includes board-certified heart failure cardiologists, cardiothoracic surgeons, advance practice nurse, clinical pharmacists, social workers and clinical engineers.

Dominic Alexander, a clinical engineer who works extensively with patients on devices, said he likes to consider the patient’s “thrival” rate, not just the survival rate. “We don’t just save lives, we help people get to the next step in their lives. This may be bridge to transplant, bridge to decision, bridge to recovery, or bridge to destination,” he said.

Clinical Research

UA Sarver Heart Center has a number of clinical trials underway focused on heart failure. Please complete a Cardiology Research Registry Information Form to learn about new clinical research studies for which you may be eligible.

We want our patients to thrive.

Jennifer L. Cook, MD, is an associate professor of medicine at the UA Sarver Heart Center and director of Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation at Banner – University Medical Center Tucson.

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