In 2015, Dr. John King, a cardiologist at Baptist Memorial Hospital-Golden Triangle, heard about a device that could help him treat difficult-to-manage heart failure patients. His response, as he recalls, was one of excitement.
“I just kept thinking, finally, a way to treat my difficult patients,” he said. “But the health system said, ‘Well, maybe, let’s wait a little while and see.’ That was difficult to hear.”
The CardioMEMS device is tiny, small enough to fit inside a heart failure patient’s pulmonary artery, the artery that runs from the heart to the lungs. The device is designed to help doctors monitor signs of heart disease by collecting data from inside a patient’s body and transmitting it directly to King’s office via, of all things, a monitoring pillow that implant recipients lay on once a day. The pillow receives and reads a wireless signal from the CardioMEMS implant, then sends the data to King’s office.
“It’s really a neat gadget,” King said. “It sounds a little crazy, transmitting data like that, but it’s really a great way to communicate that kind of information.”
Two years later King finally got his wish. BMH-GT gave King, and the CardioMEMS device, the go-ahead in 2017. In August 2018, King performed the region’s first CardioMEMS implant on an 85-year-old heart failure patient from Lowndes County.
Before the implant, King could never find a “happy medium” for his patient.
“He was sort of brutal to manage,” King said. “We’d think we’d got it right and then he’d go out and do well for a little while and he’d come back having problems again.”
But now, because of the daily monitoring the implant provides, King has a more efficient way to see patterns in his patient’s health and, more importantly, see if another heart failure is coming.
“Typically what we see in most heart failure patients is that their pulmonary artery pressures start to rise before they even experience problems,” he said. “Usually you have several days to a week, or even a couple weeks of lead time before they start getting significantly short of breath or wind up admitted to the hospital.”
Overall, that is the value the CardioMEMS implant provides, King added.
“Instead of having patients come in all the time for our own monitoring, we can get data from them daily,” he said. “Because one reading isn’t enough. We’re looking at trends over a period of time in order to determine if there is something we need to worry about, or just a blip of data we can ignore.”
At $30,000 for the implant, surgery and monitoring pillow, King knows the device doesn’t come cheap. But since he only has one patient who uses the device thus far, he doesn’t charge a fee for monitoring the data that comes to his office twice a week from the monitoring pillow.
“Eventually, we’ll be paid (for patient data monitoring) by Medicare,” he said about the single CardioMEMS patient whose care he oversees. “But there’s sometimes a lag between something coming into the market and when it’s covered by insurance. But right now, since we just have one patient, I’m not going to let the cost of monitoring stand between giving a patient care.”
King has approached several other eligible patients about potentially receiving a device, but encounters roadblocks more often than not.
“But patient selection is tricky, and that’s one of the harder things about it,” he noted.
Patients must have been admitted to the hospital for heart failure a year prior to receiving the implant and they must have a chest circumference of under 60 inches.
“Not everybody is small enough, chest-wise for it to work,” said King. “It has a limited signal range, so extremely large individuals can be difficult to get any kind of measurement off of. Unfortunately, some of our patients that we would’ve really liked to give the implant to are some of our obese patients, who can’t have it because of the signal.”
Those parameters are set by the clinical trials that legitimized the CardioMEMS device back in 2015, King said. He has an additional set of criteria that goes beyond a patient’s physical condition.
“You also have to have patients that are motivated,” he said. “You’re putting a permanent device in their artery. (They’ve) got to be willing to use it, willing to lie on the pillow, willing to communicate back to the office if there are problems and willing to receive communication with us.”
Part of advancing patient care is exploring innovative technology like CardioMEMS for patients who are difficult to treat, says BMH-GT CEO Paul Cade. At the end of the day, it’s about making patients feel better.
“This procedure can help improve their quality of life and, we hope, reduce their chances of being readmitted to the hospital,” he added.
Even though insurers and health systems seem to be unsure about the CardioMEMS implant, King believes it’s part of the future of heart failure patient management.
“This thing is going to have proven worth,” he said. “This is a tool that patients can use and we can use to improve their care.”