Recent clinical trials have shown that information provided by the CardioMEMS device can reduce hospital readmissions by about 37 percent. Cardiologists at Cardiovascular Associates (CVA) in Birmingham implanted one of the first devices in Alabama following the May 2014 approval of the device by the FDA. They have been using the monitoring system for heart failure patients since early 2015.
“Congestive heart failure is a difficult problem that affects a patient’s lifestyle and also the country’s economy as a utilization of health care,” says Barry Rayburn, MD of CVA. “Regardless of what kind of disease caused the heart failure, when one of these patients is admitted to the hospital, the risk of readmission within the next three to six months is high. Those readmissions often become repetitive, with a patient being in and out of the hospital several times over a few months.”
The primary goal of treating heart failure is to extend a patient’s life and to reduce symptoms. “We know that by keeping patients out of the hospital, we can prolong their lives, not just manage their symptoms,” Rayburn says. “Measuring how often a patient comes to the hospital is a useful fact and has led to a variety of monitoring strategies, which have shown that there almost always is a lead time of up to a couple of months where a patient’s condition begins to deteriorate while they are at home. If we can catch that downturn earlier, we may can stop it and prevent the patient’s admission to the hospital.”
Reducing the hospitalizations as well as medical costs was a driving force behind the development of the CardioMEMS, which allows medical personnel to monitor pulmonary artery pressures from the patient’s home or other remote locations. Pulmonary artery systolic pressure is a strong predictor of death in heart failure patients, and remote monitoring of that information is helping medical personnel stay abreast of their patients’ conditions.
“The device is small, about the size of a grain of rice, and is mounted inside a small block of inert plastic. A couple of small ropes of wire hold it in place. It has no battery and it has no internal power supply, so it can be used indefinitely and doesn’t have to be replaced,” Rayburn says. “In the catheterization laboratory, a cardiologist places the device into one of the pulmonary arteries that sits behind the heart. For the remote monitoring, the patient is given a pillow with an antenna inside it and a small box that is the control system. Once a day, the patient lies down on the pillow and the antenna sends a signal to the device. The reading takes about 18 seconds. The device then transmits information about the pulmonary artery pressure and heart rate back to a secure web site where the medical team can access it. We watch the pressure trend and if we see it going in the wrong direction, we will contact the patient, maybe bring him into the office or adjust his medication. It allows us to do something to treat the problem before it gets to the point that the patient has to be hospitalized.”
Several CVA patients who use the CardioMEMS system are more comfortable with the remote monitoring. “Some of the patients feel better because we have a better handle on their situations,” Rayburn says, “and being able to access their information on a regular basis allows us to be more proactive with adjusting medications between visits.”
Rayburn is optimistic about this new treatment device and hopes the medical community and insurance companies can work together to make sure this opportunity is extended to all who need it. “We are still early enough in this process that reimbursement models for the work involved with ongoing remote monitoring haven’t been established. I think this is a ripe opportunity for payers who are interested in improving quality care at a reduced cost could partner with providers. By creating a model where the extra work, the extra burden of providing this monitoring, and proactively reacting to the changes is actually reimbursed in a meaningful way, it is likely that they would be reducing costs for hospitalization, patient outcomes, and more,” he says. “This is a classic example of a procedure that can contribute to value-based and quality-based medicine.”
