Thursday, August 24, 2000

Device tracks ailing hearts


New implant can warn of changes in function

By Steve Bailey
The Associated Press

        LEXINGTON — Susan Levy is sick and tired of feeling sick and tired.

        On oxygen since October because of congestive heart failure, Ms. Levy is often short of breath and has trouble doing simple everyday tasks like going to the mall, grocery shopping or even walking up a flight of stairs.

        “I'd just like to start living a normal life again,” said Ms. Levy, 61, of Cincinnati. “I have five children, two grandchildren and a lot of friends I'd like to spend more time with. I just don't physically have the energy to do much of anything.”

        An experimental device being tested at the University of Kentucky's Chandler Medical Center may help Ms. Levy reach that goal.

        On Tuesday, physicians and staff at the center's Gill Heart Institute implanted a pacemaker-like device in Ms. Levy's chest that will allow them to monitor her heart function long distance via the Internet.

        The Chronicle Implantable Hemodynamic Monitor (Chronicle IHM) is the world's first implanted monitor for the medical management of heart failure patients. About 100 of the experimental devices have been implanted at eight centers across the country.

        While Mrs. Levy became one of the first two patients in Kentucky to receive the experimental heart failure monitor, she isn't the first Greater Cincinnati resident to receive one.

        Several of the devices have been installed at University Hospital as part of research studies there, said Dr. John Wilson, a Cincinnati cardiologist.

        In fact, Dr. William Abraham, the study's lead investigator and co-director of the Linda and Jack Gill Heart Institute at the University of Kentucky, recently took that position after leaving University Hospital.

        In recent years, some Cincinnati-area residents with heart failure have been fitted with experimental pacemakers. Others have received similar-sounding monitoring devices that can track irregular heart beats.

        The new heart failure monitor is different from those devices, Dr. Wilson said. It does not treat heart failure, but previous studies in Europe indicate that the device can allow doctors to detect problems earlier and adjust medication doses before the patient needs hospital care, he said.

        The Gill Heart Institute, which also implanted the device in a 50-year-old Ashland woman Tuesday, is the only facility in Kentucky that offers this form of treatment.

        Nearly 5 million Americans and an estimated 60,000 Kentuckians suffer from heart failure, a debilitating condition in which the heart does not pump enough blood. Heart failure results in fatigue, shortness of breath, swelling and decreased life expectancy, and is the most common cause of hospitalization for the elderly.

        “This device has the potential to change the way we treat heart failure patients,” Dr. Abraham said at a news conference Wednesday. “With this device, we can see how a patient in another part of the state is doing without the patient having to go to a hospital to undergo an invasive procedure.”

        The device, which is about the same size and shape as a pacemaker, continually monitors the heart's function by measuring and recording the changes inside the heart that indicate how efficiently it is pumping. It consists of a small computer that records the heart's pressures, performance, heart rate and activity levels.

        That information can be downloaded by the patient on a daily basis and transmitted over telephone lines to a secure Web site accessible to the center's heart failure team. This method could help patients avoid the need for invasive exploratory procedures, such as heart catheterization.

        There are certain risks involved.

        “The largest risk that we worry about with any device that's a foreign body such as this is the risk of infection,” said Dr. Westby Fisher, an electrophysiologist at the Chandler Medical Center. “And as with any surgery that deals with devices implanted in the heart, it could lead to an arrhythmia. Either of those could potentially cause death.

        “But the risk of putting one of these in is really no different than implanting a standard pacemaker, which has been found to be extremely safe in even the most elderly populations.”

        Dr. Abraham said the device should help doctors cut down on some of the guesswork that goes along with treating heart failure.

        “Unfortunately, at the present time, we don't have a cure for heart failure,” said Dr. Abraham, who guessed that the device may be approved for widespread use by 2002. “So the treatment really is symptomatic. The Chronicle, by giving us information in addition to symptoms and in addition to a physical examination, may help us do a better job treating those symptoms and may help us use necessary medicines a bit smarter than we do right now.”

        Dr. Abraham said the cost of the device and its implantation is $12,000 to $15,000. It could, however, save in the long run.

        “The average cost of a hospitalization for heart failure is about $12,000,” he said. “Avoiding just one hospitalization can recoup perhaps all or most of the cost of implanting the device. If you avoid two hospitalizations, you clearly are in a cost savings mode.”

        Ms. Levy said she's excited by the hope that doctors will be able to improve her quality of life.

        “Anything that will allow me to feel better and maybe have more energy to travel or play with my grandchildren is a wonderful thing,” she said.

        Enquirer reporter Tim Bonfield contributed.

       



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