Muhammad Raza, MD, FACC -- Medical Director of the Structural Heart Disease Program at Chester County Hospital
Changes in lung blood pressure can signal big trouble for people with heart failure. Now, thanks to a tiny implantable device being offered at Chester County Hospital, these changes can be identified and addressed at their onset, before the disease worsens.
The first-of-its-kind procedure for the hospital has the potential to be "life-changing" for qualifying patients, says Muhammad Raza, MD, FACC, an interventional cardiologist and the medical director of the Structural Heart Disease Program at Chester County Hospital in West Chester, PA.
“It is an invasive procedure, but it’s a one-time instance,” Dr. Raza says. “And once it’s in place, this device could help heart failure patients better manage their symptoms, which would improve their quality of life and decrease their rate of hospitalization.”
For those with heart failure, changes in blood pressure through the pulmonary artery can be an indication that the disease is worsening, even before symptoms like shortness of breath and weight gain become apparent. The CardioMEMS HF System features a small pressure-sensing device that is implanted directly into the pulmonary artery. It will regularly send information wirelessly to the patient’s cardiology care team. Should a change in blood pressure be detected, the team can intervene immediately.
"We might ask them to increase their diuretic therapy, or visit our office so that we can administer extra diuretics intravenously, whatever’s needed to prevent them from being admitted to the hospital," says Kristy Panichelli, CRNP, a cardiology nurse practitioner at Chester County Hospital and Cardiology Consultants of Philadelphia/West Chester.
Reversing a Troubling Trend
Before the advent of the CardioMEMS HF System, changes in blood pressure through the pulmonary artery usually went undiagnosed (and untreated) until the patient began experiencing symptoms. Between the start of those changes and the onset of symptoms, as much as two weeks could pass. Often by that point, hospitalization was the only effective course of treatment.
Beginning a few years ago, hospital readmissions in the United States came under increased scrutiny as part of a larger effort to reorient the healthcare system. With chronic conditions on the rise, the growing consensus was that too many treatment plans lacked a clear focus. In the course of this movement, congestive heart failure received the most attention as the number one cause for hospitalization in the US, says William Clay Warnick, MD, the medical director of the Cardiovascular Service Line at Chester County Hospital.
William Clay Warnick, MD -- Medical Director of the Cardiovascular Service Line at Chester County Hospital
That frequency was especially concerning because repeat hospitalizations for heart failure patients are a strong predictor of the disease worsening and, ultimately, the patient’s death. In other words, each hospitalization for someone with heart failure is an irrevocable step in the wrong direction.
"While this device has been available for several years, it warranted our attention now because it’s gotten the most traction in terms of altering that curve," Dr. Warnick says.
The CardioMEMS HF System has been clinically proven to reduce hospital admissions by 58 percent over an average of 12 months, according to its manufacturer, Abbott. "There’s new data that indicates this device also improves quality of life because patients who’ve had it implanted feel like they have better control over their disease," Panichelli says.
To be considered for implantation at Chester County Hospital, a candidate must have been hospitalized at least once over the last year. They also need to be experiencing "moderate symptoms, like shortness of breath, with only mild activities of daily life" such as walking up a flight of stairs, Dr. Warnick says.
"We’re also taking into consideration whether the candidate has a history of being compliant with their treatment and therapy," Panichelli says.
Candidates can be diagnosed with any type of heart failure
"This is another tool in our toolbox to help patients at risk of congestive heart failure," Dr. Warnick says. "It affords us the opportunity to detect changes in their condition much sooner, which will hopefully translate to fewer hospitalizations."
The Power of Joining Forces
While the CardioMEMS HF System is in its infancy at Chester County Hospital, the infrastructure around it is not. "We’re benefitting from our close relationship with the heart failure team at Lancaster General Hospital, which is led by Dr. Justin Roberts and nurse practitioner Lisa Rathman," Dr. Warnick says.
Under Dr. Roberts, Lancaster General Hospital, which is also a member of the Penn Medicine health system, began implanting the CardioMEMS HF System several years ago. Dr. Warnick says their data was integral in the decision to make the device available at Chester County Hospital.
Rathman and Dr. Roberts also shared all their related protocols, including their criteria for selecting candidates for implantation and how patients who’ve had the device implanted are monitored.
Another critical component is Dr. Raza himself. Dr. Warnick is a clinical cardiologist who specializes in the care management of heart failure patients. Missing from the equation was an interventional cardiologist with the necessary skillset to perform the implantation. That changed when Dr. Raza joined Chester County Hospital last year.
"As healthcare becomes more sophisticated, it only makes sense for providers with different skillsets to join forces," Dr. Raza says. "This is a great example of that. Together, Dr. Warnick, Kristy, and I are able to deliver a high level of care that we wouldn’t otherwise be able to."
Related Information from Chester County Hospital: