Medical Device Daily Washington Editor

NEW ORLEANS – Just in the last few years, the approach to heart failure treatment has gone through dramatic change, and the pace – pardon the pun – is not slowing.

That was the main message from Robin Germany, MD, cardiologist at University of Oklahoma Health Sciences Center (Oklahoma City), during last week’s Heart Rhythm 2005 gathering.

Germany offered her thoughts on changes in heart failure treatment from a physician’s perspective.

“Only a few years ago, most heart failure treatment programs in the U.S. were focused on getting patients to transplantation,” she said. “If you look today, biventricular pacing and ICDs [implantable cardioverter defibrillators] are really where we’re at. Now where do we go from here?”

When heart failure drug therapies such as ACE inhibitors and beta-blockers became available, the beginning of a culture change emerged, resulting in decreased mortality by 40% to 45% in the last 10 years.

“But now with studies such as MADIT I and MADIT II showing that these devices are really benefiting patients,” she said, “we now have to look at the whole disease process differently. Perhaps devices actually may be the key to our chronic management.”

Transplants aren’t needed as often, and patients are living longer, Germany explained. But that encouraging news still comes with many challenges.

“Part of the culture change means we’re not looking at transplantation as the end all or be all, but if you look at the incidents of sudden cardiac death in this country, we are will missing a tremendous amount of these patients,” she added.

Germany suggested that heart disease is something that must be approached with more of a long-term focus, saying that it will have to be managed more as a “diabetes-type chronic condition.”

“I have several patients in their 30s, and they could live another 50 years with biventricular ICDs,” she said. “How many devices am I going to have to implant and pull out?”

As patients live longer, the management of their devices and their care come into question. More clinical trials showing longer-term data will be helpful, she noted.

Devices, while helping patients lead longer and fuller lives also are providing insight into better treatment options.

“Devices and Internet-based technology can provide us so much information we can use to help our patients,” Germany said.

One of the slides she used during her presentation showed the heart rate variability in one of her patients. The graph showed heart rate during a fight with a child and then during a period when the patient (a little binge eating because of the stress, Germany said) had eaten pizza. The monitoring device also was able to show the recuperative effects drugs had on the trauma wrought during both the dispute with the child and gustatory struggle with the pizza.

The care for these patients is going to have to be a joint effort among cardiologists, electrophysiologists and internists, she said.

“Now that patients are living forever,” Germany said, doctors in different areas will have access to a wealth of data from one patient, and they will all have to communicate regarding the patient’s care.

She added: “That’ll require a change in mindsets.”