Implantable PA monitor used in UH program decreases heart failure hospitalizations and ED visits by 80 percent
Innovations in Cardiovascular Medicine and Surgery - Summer 2018
GUILHERME OLIVEIRA, MD
Director, Advanced Heart Failure and Transplant Center, and Director, Cardio-Oncology Program, University Hospitals Harrington Heart & Vascular Institute, Lorraine & Bill Dodero Master Clinician in Heart Failure and Transplantation; Professor of Medicine, Case Western Reserve University School of Medicine
MONIQUE ROBINSON, MD, PhD
Advanced Heart Failure and Transplant Center, University Hospitals Harrington Heart & Vascular Institute; Clinical Assistant Professor of Medicine, Case Western Reserve University School of Medicine
The heart failure specialists at University Hospitals Cleveland Medical Center were early adopters of CardioMEMS, the miniaturized, wireless sensor implanted to continuously monitor pulmonary artery (PA) pressures. Three years after first employing the device, the UH team is now using it to manage 75 heart failure patients – with impressive results.
“The landmark CHAMPION trial showcased the utility of CardioMEMS in reducing heart failure hospitalizations. It showed had a reduction of roughly 30 percent,” says heart failure specialist Monique Robinson, MD, PhD, who manages the CardioMEMS program at UH. “That was based on individual centers enrolled in that trial using their own approaches. What we have done at UH is devise an algorithm-based management style. That standardizes care for all of our patients.
Through the end of 2017, our reduction in heart failure hospitalizations and ED visits, compared with a year before implementing CardioMEMS, was 80 percent.”
Data from the CardioMEMS sensor allows the heart failure team to make adjustments to diuretic therapy at the earliest signs of PA pressure abnormalities -- almost in real time. However, importantly, the heart failure patient is not burdened with more office visits.
“One of the great advantages of this is that patients don’t need to come in as frequently,” says Guilherme Oliveira, MD, Director of the Advanced Heart Failure and Transplant Center at UH Harrington Heart & Vascular Institute. “This is all done over the phone. People that I was having to see every other week because they were so decompensated and I was making so many changes, now I can see every four months. This technology is game-changing for the outpatient management of heart failure patients.”
Patients receiving a CardioMEMS sensor at UH can have it implanted at the main academic medical center or one of the UH community hospitals. A staff of physicians, nurses, nurse practitioners and administrators, however, monitor all patients from a central location at UH Cleveland Medical Center.
“We decided that the way it was going to work best is to have the device implanted locally, but monitored centrally by our specialized heart failure group,” Dr. Oliveira says. “We follow each patient, using our algorithm, in partnership with their local cardiologist.”
Both Dr. Robinson and Dr. Oliveira cite the treatment algorithm as one key to the program’s almost unprecedented success. However, they say, strong relationships with patients and fellow healthcare providers also play an important role.
“We’ve created a standard way of managing that everyone in the group is aware of and on board with,” Dr. Robinson says.
“Through this program, we also create a meaningful link with our patients. We listen to their feedback. We also get feedback from our physician colleagues, who know what has worked with these patients in the past. Instead of us taking over, it’s just an additional way to help them get and keep their patients well. The feedback we’ve had has been overwhelmingly positive.”
In addition to providing more timely information about patients’ PA pressure changes, a CardioMEMS program can also expedite identification of those patients who need more extensive treatment.
“Using PA monitoring, we find patients who, despite our best efforts, have not been able to get to their PA pressure goals,” Dr. Robinson says. “For those patients, we can begin considering LVADs or even heart transplantation. It’s a way to get them on the path to more definitive therapy sooner. A lot of the physicians we’ve worked with have found this very useful.”
For more information about the CardioMEMS program at UH Harrington Heart & Vascular Institute or to refer a patient, please call 216-844-3800.