An Innovative Approach to Heart Failure Management

An Innovative Approach to

HEART FAILURE MANAGEMENT

by, Philip B. Adamson, MD, MSc, FACC

Despite medical advancements, heart failure is a worsening epidemic.

The number of people in the United States with a diagnosis of chronic heart failure is expected to double in the next 15 years–forcing physicians to face the significant challenge of delivering quality health care for a growing population.

There are many medications and devices focused on heart failure management that bring great hope for clinical improvement–and the potential for recovery. Even still, there is a significant gap in treatment options.

For example, half of the approximately six million people living in the United States with symptomatic heart failure have a normal ejection fraction. While there has historically been limited medical therapies to improve patient outcomes, new innovations are allowing us to identify advanced heart failure patients earlier in their progression, resulting in improved survival and quality of life.

REMOTE HIGH-TECH MONITORING

As a heart failure cardiologist, I can attest to the emotional and physical burden that this disease brings to patients and their caregivers, especially when hospitalization is needed. Heart failure remains the leading cause of hospitalization in Medicare beneficiaries, and accounts for a large percentage of the overall $40 billion cost of expenditures. In fact, clinical evi-

the Abbott CardioMEMS HF System™,

dence shows that increased hospitalizations can actually compound challenges for patients and lead to worsening cardiac function and even mortality. This is important since hospitalizations for advanced heart failure patients tend to be recurrent with 25 percent of patients readmitted within 30 days and 50 percent within six months.

While Medicare penalties through the Hospitalization Readmission Reduction Program appear effective in lowering 30-day readmissions, recent analyses suggest that increased mortality is associated with the national trend for reduced readmissions. This phenomenon does not appear to be the case with other targeted reasons for hospitalizations, such as myocardial infarction and pneumonia.

One major challenge in clinical management of patients with heart failure is that most of the patients’ lives are spent away from their health care provider, leaving physicians to rely on a reactive approach for managing their patients once symptoms present. Many patients also feel very anxious when they are not in the general proximity of their care team, which limits their ability to travel or enjoy visiting loved-ones who do not live nearby. Traditional methods of tracking have not overcome this issue, since relying on changes in physical symptoms simply does not help keep patients from developing acute decompensation.

One novel solution to this problem is the, Abbott CardioMEMS HF System™, which consists of a tiny permanently implanted pressure sensor in the pulmonary artery (PA) with the ability to remotely measure PA pressures daily

the Abbott CardioMEMS HF System™,

from the patient’s home. This continuous monitoring alerts the patient’s care team when PA pressures are rising. This is critical as PA pressures increase long before patients develop worsening symptoms or changes in weight. The automatic notification process, coupled with the ability for providers to routinely review patients’ PA pressures, has revolutionized the heart failure disease management paradigm by providing an early warning system for physicians to more proactively manage the care of their patients.

The CardioMEMS HF System™ also allows patients to know that, no matter where they are, they can be monitored with clinically actionable information. In fact, the information provided by PA pressure monitoring takes the guess-work out of managing symptoms, weight changes and even estimation of disease progression by physical examination. Instead of a gross approximation of PA pressure–this technology provides the actual number to inform personalized remote management.

FDA APPROVED, ON THE MARKET AND BACKED BY CLINICAL DATA The CardioMEMS HF System™ is the first and only FDA-approved heart failure monitoring device of its kind to significantly reduce hospital admissions for NYHA class III heart failure patients who have been hospitalized in the previous 12 months. The technology has been proven to reduce hospital admissions by 37 percent when used by physicians to manage patients with previously hospitalized and persistently symptomatic heart failure after 15 months of follow-up. Approximately 10,000 patients have been implanted with the device as of September 2018. While this marks a major milestone, we know the potential for greater adoption is high. The GUIDE-HF trial, the largest heart failure medical device trial in history, is now underway and builds on previous clinical trials to study whether the CardioMEMS HF System™ can improve survival and quality of life while reducing heart failure hospitalizations for people living with NYHA class II-IV heart failure. The five-year investigational study launched in March 2018 and is open to hospitals and eligible to patients nationwide.

REDEFINING HEART FAILURE MANAGEMENT

Managing the oppressive morbidity and mortality associated with heart failure is a daunting challenge for patients and health care providers. Innovative sensor technologies, such as remote PA pressure monitoring, represent a tangible tool to help manage the pandemic of heart failure. This technology is available and ready for integration into routine clinical practice for patients living with advanced heart failure.

Philip B. Adamson, MD, MSc, FACC is a Heart Failure Cardiologist and Medical Director at Abbott. Prior to his work at Abbott he served as director of the Heart Failure Treatment Programs at the University of Oklahoma Health Sciences Center and The Oklahoma Heart Hospital in Oklahoma City.

Abbott

Empowering the

TRANSFORMATION OF HEART FAILURE

Innovating with product solutions that set new standards of care across the heart failure continuum

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