Friday, July 24, 2009

At-home heart care

Doctors at the MGH Heart Center have implanted the first patient with a new device they hope will reduce hospitalizations for heart failure. The Homeostasis II trial will evaluate the effectiveness of a system that allows patients to monitor their heart function at home and change their medication dosage daily to prevent more serious symptoms.

"This device could change the playing field of how we monitor and treat patients with heart failure," said Jagmeet Singh, MD, PhD, director of the Cardiac Resynchronization Therapy program and co-investigator of the study.

Hospitalization rates for people with heart failure have increased dramatically in the past three decades, and an estimated 5.7 million Americans are living with the disease. Repeat hospitalizations for symptoms -- such as fluid build-up, swelling and shortness of breath -- are a burden for both patients and the health care system, with the total annual cost of care in the United States in the billions of dollars.

The Homeostasis II trial aims to show that at-home monitoring can keep patients out of the hospital. In June, Singh implanted a sensor the size of a dime in the left ventricle of Raymond Racette's heart. The sensor monitors left atrial pressure and sends it twice daily to a small hand-held computer. Using this information, Racette will be able to adjust his medications on a dose-by-dose basis, much like diabetics adjust their insulin dosage based on the results of at-home glucose monitoring.

"The hope is that he and future patients will be able to take care into their own hands," said Stephanie Moore, MD, the trial’s principal investigator.

The Homeostasis II trial is also evaluating whether left atrial pressure, measured from within the heart, can indicate impending problems hours or days before more serious symptoms occur.

"In the past, the only time I knew I was having a problem was when I would start having difficulty breathing," says Racette, who was diagnosed with congestive heart failure in 2002. "I was being considered for a heart transplant. Hopefully this will carry me through so I won’t need to go down that road."

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