Cardiovascular Business - January/February 2009 - (Page 10)

Device trenDs › BY C.P. K AISER Heart Failure Care Gets Boost from technology A tion and identifying who is most likely to benefit from a VAD. nalysts forecast an increase in the number of Study co-author Joseph G. Rogers, MD, medical director of the heart failure patients, going from 6 million Cardiac Transplant and Mechanical Circulatory Support Program in 2007 to more than 30 million in 2037. This at Duke, says it’s important to acknowledge the “absolutely disrapidly expanding patient population will chalmal prognosis these patients have.” Even lenge cardiologists, allied though survival rates in the study looked health personnel and equipment modest (50 percent), they are a “drastic and device manufacturers to keep improvement from other options for pace with ever-changing ways to these patients.” Survival rates for patients improve care and survival rates. on optimal medical therapy are about 10 A recent development in the field is the percent. Newer pumps, which are smallnod in September 2008 by the American er and more durable, lasting up to six Board of Medical Specialties to establish years compared to 18 months for today’s a secondary subspecialty certification in pumps, show a survival rate of 70 percent Advanced Heart Failure and Transplant in preliminary data, Rogers says. Cardiology. “Over the last several years, Duke researchers also found a corits has become more evident that some relation between successful outcomes physicians were identifying themselves as and procedure volume. “This is not a heart failure specialists but with no stantherapy one can dabble in and expect to dardized training requirements,” says Unlike earlier-generation devices, newer ventricular assist devices are smaller and more durable, lasting have good outcomes,” he says, adding Marvin Konstam, MD, former president beyond ﬁ ve years. that appropriate surgical and pre- and of the Heart Failure Society of America post-operative infrastructure are key. and a professor of medicine at Tufts University. He notes that the Hospitals anticipating opening a heart failure program should move will bring a higher level of care to patients. expect a reasonable upfront infrastructure cost. Rogers’ experiMost heart failure programs incorporate teams of cardioloence indicates that many programs are not losing money. In fact, gists and allied health personnel such as nurse practitioners, this patient population can be a driver for downstream costs. registered nurses and exercise physiologists who specialize in “They utilize hospital services extensively,” he says. heart failure. Patients are increasingly receiving ventricular assist devices (VADs). Thriving heart failure programs have access to many FDA-approved mechanical VADs including the HeartRemote monitoring mate, Novacor, Debakey, Jarvik and other devices. Physicians at Heart failure patients with severe or moderately severe symptoms the Cleveland Clinic, for example, have implanted more than 500 are sometimes candidates for cardiac resynchronization thersuch devices and researchers there are participating in two ranapy (CRT) through the implantation of biventricular pacing domized trials comparing permanent support with an implantdevices. Some of these patients benefit from a combination able pump (Novacor) and a continuous ﬂow pump (Debakey) to of CRT and an implantable cardioverter defibrillator (ICD) the Heartmate device. to control concomitant tachycardia. Several trials in progA recent study from Duke University Medical Center, howress, including MADIT-CRT and DETERMINE, are studying ever, found that VADs are associated with high hospital costs whether earlier intervention with a device can prevent heart and high rates of early death among Medicare recipients (JAMA failure in patients with preserved ejection fractions and other 2008;300(20):2398-2406). The researchers concluded that physiconcomitant conditions such as coronary artery disease and cians need to do a better job defining the time of optimal intervenmyocardial infarction. 10 cardiovascular Business January/February 2009

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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