A new device that allows doctors to detect early signs of deterioration in patients with heart failure could cut hospital readmissions by more than 50 per cent.
The small wireless device known as CardioMEMS is implanted into the pulmonary artery. It remotely monitors changes in pressure that can indicate the build-up of fluid in a patient's body days before they experience symptoms such as shortness of breath, fatigue and swelling.
Doctors at Cleveland Clinic Abu Dhabi have implanted the device in two Emirati patients, a man and a woman in their 60s, in the first such procedures in the emirate.
More than 64 million adults worldwide are living with heart failure, a condition in which the heart cannot pump enough blood to meet the body’s needs.
Nadya Almatrooshi, a staff doctor in cardiovascular medicine at the Heart, Vascular and Thoracic Institute at Cleveland Clinic Abu Dhabi, is optimistic about the impact of the device.
“Studies have shown that remote monitoring can reduce heart failure readmissions by up to 57 per cent,” Dr Almatrooshi told The National.
“This device gives us an alert before the symptoms start, so we can act earlier. The patient may then avoid having to come to hospital.”
Heart failure has a number of causes, with coronary artery disease and uncontrolled high blood pressure among the most common. Genetic conditions, congenital heart disease and infections can also lead to heart failure.
One of the greatest challenges in managing the condition is preventing patients from repeatedly having to go to hospital.
“The main reason for readmission is decompensated heart failure, when the patient develops fluid overload,” Dr Almatrooshi said. “Sometimes they need to be admitted to hospital and require IV [intravenous] diuretics or other IV medication.”
She added: “Studies have shown that after the first [hospital] admission, the mortality rate for heart failure patients can reach up to 50 per cent within one year.”
Minimally invasive
CardioMEMS is permanently implanted during a minimally invasive procedure in the catheterisation laboratory.
The sensor measures pressure in the pulmonary artery, the vessel that carries blood from the heart to the lungs. Rising pressure can provide an early indication that a patient’s heart failure is worsening.
Once home, patients are given an electronic pillow that communicates with the sensor. The patient is required to lie on the pillow for 15 to 20 seconds each day for a reading to be transmitted to the heart failure team at Cleveland Clinic Abu Dhabi.
Patients are encouraged to take their readings at roughly the same time every morning before beginning their normal activities. Readings are reviewed every day by the heart failure team.
Nurse Shaira Villa, who has worked with heart failure patients at the hospital for eight years, said the technology allows the team to detect changes while patients are still at home.
“Even though patients are not physically coming to the hospital, I will know if the patient is becoming fluid overloaded,” she said.
“I have one patient whose medication we have adjusted several times because we noticed changes while the patient was at home.”
Patients with heart disease may be advised to restrict their fluid and salt intake because excessive amounts can contribute to fluid accumulation.
Telltale symptoms
Fluid accumulation in people with worsening heart failure can cause shortness of breath, fatigue, swollen legs and difficulty carrying out everyday activities.
“Some patients may forget their fluid restrictions or increase their salt intake when they are at home, and this can trigger fluid overload,” Ms Villa said.
“The advantage of this device is that I can see that change straight away. I can call the patient and ask about their symptoms, but usually symptoms develop much later. We can manage the fluid overload before those symptoms even start.”
Dr Almatrooshi said avoiding repeated admissions could also reduce the risk of further complications.
“Every time a patient comes into hospital, there can be complications,” she said. “They may develop an infection, acute kidney injury or liver injury.
“The second advantage is that we can treat them before the symptoms start. We act early, so the patient may not develop symptoms at all and can continue with their normal daily activities.”
Remote monitoring also allows the medical team to adjust medicines such as diuretics, which help remove excess fluid from the body but can affect kidney function.
“By adjusting this medication, we can give the proper dosage for the patient,” Dr Almatrooshi said.
Not for everyone
CardioMEMS is not suitable for everyone and patients are assessed to determine whether they would benefit.
For patients whose heart failure continues to progress despite medication, other treatments can include implantable cardiac devices and left ventricular assist devices, or LVADs, which mechanically support the heart’s pumping function.
Heart transplants remain the gold-standard treatment for suitable patients with advanced heart failure, Dr Almatrooshi said.
Cleveland Clinic Abu Dhabi has performed 49 heart transplants since its programme began in 2017.
But the aim of remote monitoring is to intervene much earlier, before a patient’s deterioration becomes serious enough to require another hospital stay.
“It changes the patient’s life,” Ms Villa said. “One of my patients said, ‘Why did you not implant this device in me before?’”
