Device Technologies to Reduce Heart Failure Readmissions
In the past few years there have been a number of device therapies developed to treat heart failure (HF). This is partly in response to the Centers for Medicare and Medicaid Services (CMS) targeting HF to reduce the staggering costs of treating patients in an HF crisis, rather than less expensive outpatient treatments. Heart failure costs the United States about $30.7 billion each year, according the Centers for Disease Control.[1] HF is also one of the single largest costs for CMS, which is why the agency has targeted HF readmissions with payment penalties to force hospitals to better manage these patients.
About 5.7 million adults in the United States have heart failure, and one in nine deaths in 2009 included heart failure as a contributing cause. About half of the people who develop heart failure die within five years of diagnosis.[1] This makes HF a possible large growth area to increase patient volumes with device therapies for cardiology departments in the coming years.
“We have entered a fabulous era of interventional heart failure technologies after spending the last three decades exploring drug therapies for heart failure, and now we have finally realized device therapies can also be useful in improving the way our patients feel and helping keep them out of the hospital, and perhaps even prolonging their lives,” said William Abraham, M.D., FACC, director of the division of cardiovascular medicine and a professor of internal medicine, physiology and cell biology at The Ohio State University Wexner Medical Center. He spoke on HF technologies at the 2016 Transcatheter Cardiovascular Therapeutics (TCT) meeting.
Abraham said TCT 2016 was really exciting because of the large number of new interventional therapies presented for heart failure.
“CMS is clearly interested in reducing the risk or the rate of heart failure readmissions, and I think most importantly, they are interested in patient-centered outcomes, such as making patients feel better and improving their quality of life,” he added. “The interventional heart failure therapies really promise to make patients feel better — a major goal for CMS — and to also keep them well and out of the hospital. Of course, there will be a cost associated with this explosion of implantable devices for heart failure, but if we can show it is clearly to the betterment of patients and also cost-effective, then we will really have a formula for success.”
Watch a VIDEO discussion with Abraham in “Technologies to Reduce Heart Failure Readmissions.”
Abraham served as principal investigator of the CHAMPION Trial for the CardioMEMS device. The CardioMEMS HF system is a wireless pulmonary artery pressure monitoring system and was one of the biggest advances in HF technology in the past decade. Cleared by the U.S. Food and Drug Administration (FDA) in May 2014, it detects fluid retention due to worsening congestive HF symptoms and can alert clinicians prior to the patient needing hospitalization.
“It allows us to manage heart failure in a very proactive way, rather than in a reactive way,” Abraham said. “If pressures become elevated, we can adjust drug therapies to lower them and we can keep them there. This really creates a situation in which the patient is at the lowest risk for rehospitalization.”
“Since the original study, where we demonstrated a marked reduction in the risk of recurrent heart failure rehospitalizations, we have now looked at the data from the CHAMPION Trial in a variety of ways, including HFpEF (HF with preserved ejection fraction) and HFrEF (HF with reduced ejection fraction), and patients with numerous co-morbidities, such as chronic kidney disease, the effects on 30-day readmissions and on and on. No matter how you cut it, the trial comes out markedly positive, so we know pulmonary pressure-guided heart failure management substantially improves outcomes.
