Steve Szilagyi, our TBE writer is reporting from the Cleveland Clinic Medical Innovation Summit
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Chief Science Correspondent for NBC News Robert Bazell moderated the panel “Treating the Heart Failure Patient: New Technology, New Promise” at the 2011 Cleveland Clinic Medical Innovation Summit on Tuesday, October 4. Mr. Bazell recalled the hoopla surrounding the implantation of the first artificial heart in 1982, which he covered, and looked forward to hearing the latest developments in the field of mechanical assist devices. But first, he asked Cleveland Clinic cardiologist Randall Starling, MD, to give the audience a brief refresher course on heart failure.
“There seems to be a lot of misunderstanding,” said Mr. Bazell. “After all, doesn’t everybody die of heart failure?”
Dr. Starling obliged. He narrowed the definition of heart failure to “a clinical syndrome associated with weakness or stiffness of the heart muscle leading to shortness of breath or fatigue.” Heart failure was the “final pathway” for conditions like hypertension, cardiomyopathy and diabetes. “Despite the many innovations have occurred in the past two decades, almost 50 percent of patients diagnosed with heart failure will die within five years.”
In the most severe cases, heart transplant is the only treatment. But of the more than 100,000 patients who would benefit from transplant, only 2,100 or so will be able to get a new heart, due to the shortage of donor organs.
“Heart failure is a growing worldwide epidemic and the leading cause of hospitalization in theUnited States.”
Dr. Starling attributed the rising prevalence of heart failure in part to the success of cardiovascular interventions like angioplasty and coronary artery bypass, and pharmaceuticals like statins. These advances have allowed patients who might have died young of coronary heart disease to live long enough to develop heart failure – a disease of old age.
Other members of the panel were from the medical device industry. They were Gary Burbach, CEO of Thoratec, Eric Fain, MD, president of the Cardiac Rhythm Management Division of St. Jude Medicine, Douglas Godshall, CEO Heartware, and Pat Mackin, senior vice president and president of Cardiac Disease Management, Medtronic. Also on hand was Cleveland Clinic cardiac surgeon Gonzalo Gonzalez-Stawinski,MD.
Dr. Gozalez-Stawinski believed there was room for growth in organ donations – especially through educating the public and dispelling common myths about donation. He was doubtful, however, that the donor rate would ever be “one-for-one.
Mr. Bazell observed that even if the donor rate were to double, it would be “meaningless in comparison to the need”.
These comments were by way of pointing up the importance of innovations in heart-assist devices – many of which can be a “destination therapy” or alternative to transplant for some heart failure patients.
The 1982 artificial heart (implanted by former Cleveland Clinic physician Willem Kolff, MD) linked the patient to a 400 pound compressor. Heartware’s Douglas Godshall said that today’s devices are “much smaller, they’re easier to implant, and there more durable that anything that has come before.”
The cost of heart-assist devices came up – and Mr. Godshall estimated that ultimate bill for the device and the medical treatment involved might be north of $200,000. “The good news is that while this is an expensive therapy, it’s also a good therapy.” Comparing price and efficacy, he said, heart assist devices were a far better value than – for example — cancer drugs in terms of improving patients’ conditions.
St.Jude’s Eric Fain described pacemakers and implantable defibrillators as another cost effective innovation. “The therapy is a success about 98 percent of the time – a real success story in being able to treat sudden death and save lives.”
The panel discussed existing trial data and the need for further study for emerging technologies in heart failure treatment. Cost and reimbursement also came up, especially in light of the current economic downturn.
Dr. Gonzales-Stawinski observed a troubling trend of patients who have had a heart transplant in the past, and who have now lost their jobs and can no longer pay for their medications. “It’s a very complicated environment we’re practicing in,” he said. Compared to expensive technology, “preventive medicine might be a better value.”