Innovative CRTs Track Heart Patients Progress From Home

By implanting a state-of-the-art cardiac resynchronization therapy device (CRT), UMC cardiologists can connect with patients directly and get up-to-the-second information about their heart status from miles away. Cardiologists also can use the remote monitoring device to automatically obtain and record precise blood pressure and weight measurements.

"Keeping heart failure patients feeling well and physically active is a major challenge," said Dr. John P. Payne, UMC associate professor of medicine and director of the Medical Center's adult heart rhythm service. "Considerable time and effort of health care providers is required, adding to the already high cost of care. Heart failure patients must make frequent clinic visits to stay out of the hospital.

"For a rural state like Mississippi, home monitoring of heart failure patients can reduce the need for frequent long distance travel. This is a way of extending the care delivered at the office to the patients on a real-time basis as they really need it."

According to Payne, congestive heart failure is a complex condition that affects much more than just the cardiovascular system. As the heart weakens and gradually loses the ability to pump blood effectively, he said the autonomic nervous system, the stress response of the endocrine system, the kidneys, and even the liver can be affected. More than five million Americans are living with heart failure, and approximately 550,000 new cases of heart failure are diagnosed in the U.S. each year, making it the most rapidly growing cardiovascular disorder.

CRTs are indicated for patients with moderate-to-severe heart failure who maintain symptoms despite stable, optimal heart failure drug therapy. Patients must have left ventricular dysfunction (EF) less than or equal to 35 percent and QRS duration of greater than or equal to 120 ms.

Shirley Fletcher of Kosciusko said the device has saved her time and countless miles of travel. Diagnosed with heart failure in 2005, Fletcher was one of the first patients in Mississippi to receive the monitoring implant. After recovering from surgery last January, Fletcher said regular check-ups with her cardiologist couldn't be easier.

"Living far away, it's hard to go back and forth (to the cardiologist's office)," Fletcher said. "This equipment makes things much easier for me. I still have to go to the doctor every now and then, but nowhere near as often."

The integrated system includes four main parts: the wireless-enabled implantable device, an in-home monitoring unit that automatically reads and transmits information from the implanted device upon physician request; a secure Web site that provides around-the-clock access to patient data collected by the communicator; and a wireless programmer. The weight scale and blood pressure monitor are optional components.

According to Payne, UMC cardiologists have implanted more than 40 CRTs within the last 12 months. He said there are a number of home monitoring systems available for patients with implantable heart rhythm devices, including resynchronization devices for improving heart pumping action in patients with heart failure, defibrillators which protect patients from potentially dangerous fast heart rhythms, and pacemakers which treat a slow heart beat. He said information relayed remotely to the health care provider may include heart rhythm changes, device malfunction and fluid retention in the lungs.

"The system chosen for this patient (Fletcher) collects and relays simple vital signs: heart rate, blood pressure and body weight -- the kinds of things which are done at every doctor's visit and are the most basic and important data for caring for patients with heart failure," Payne said. "The system can perform a simple history, collecting important information of how the patient has been feeling. This personal and subjective information is very similar to the kind of questions asked at an actual office or clinic visit."

"Every Monday morning when the machine blinks on, it asks me questions such as how many pillows I slept on last night, or how many times I woke up breathless," Fletcher said. "I can hook the blood pressure machine to it and it reads my blood pressure automatically. When I have to weigh myself, it automatically records my weight, too."

Payne said patient response to the device has been "uniformly positive."

"For some patients, it has been an opportunity to take a more active role in managing their heart condition because they have access to the information that the health care provider has," he said. "For all, it has given them additional peace of mind that they are being cared for closely and with state-of-the-art medical technology."

Fletcher said the device not only provides her more freedom, but is representative of the excellent care and concern of cardiologists at the Medical Center.

"They've really treated me great. I can't stop singing their praises," she said. "I've already been recommending this (device) to (other heart failure) patients. It really makes a difference in your life."

For more information about the implantable CRT at the Medical Center, call 601-984-5630.