Queensland Cardiovascular Group’s cardiologists are further improving the detection and management of the complex condition of heart failure with the use of a new generation of implantable cardiac devices to save lives.
When paired with a remote home monitor, these devices can deliver a sophisticated set of heart failure diagnostics, using a multisensor approach.
Dr Hayes and the cardiologists at the Queensland Cardiovascular Group at St Andrew’s are now able to better predict the development of heart failure in a patient. Multiple sensors (heart sounds, respiration rate and volume, thoracic impedance, heart rate and activity) incorporated in the latest defibrillators and Cardiac Resynchronisation Therapy (CRT) devices are combined into one composite index to detect gradual worsening of heart failure over days or weeks and sends a single actionable web-based alert when the trend crosses a clinician-set threshold
With 67,000 new cases each year, Australia spends $3.1 billion annually on heart failure diagnosis and management, so this technology is a significant step forward, said Dr Hayes.
“The beauty of this technology and sophisticated algorithms, is that it is now far more reliable, specific, and sensitive to help cardiologists make the slightest of changes in a patient’s medications,” he said.
“Once the device is linked to a patient’s monitor at home, it can detect potentially lethal arrhythmias and other clinical signs indicating that the patient may be entering a state of heart failure, and transmit this through to the physician. It can alert the cardiologist two to four weeks before the patient develops breathlessness, that they may be going into heart failure.”
Dr Hayes suggests that for people who live in regional and remote areas, far from medical facilities, this gives more peace of mind and reduces the number of hospital visits.
“Recently we received an alert from the monitor of a patient who lives in North Queensland. It suggested he was going to go into heart failure. He felt fine and was none the wiser.
We contacted his cardiologist to adjust his medication and potentially prevented his admission to hospital with heart failure. All the indices on the device returned to normal after the adjusted medications. Improvements in programming of the devices and adjustments to medications can certainly save lives,” said Dr Hayes.
About heart failure and cardiac resynchronisation devices
Heart failure (HF) is a complex condition that often presents as:
- Exertional dyspnea (shortness of breath during exercise);
- Orthopnoea (shortness of breath when lying down);
- Paroxysmal nocturnal dyspnea (acute episodes of shortness of breath); and
Following a clinical diagnosis, HF may be categorised to whether it is associated with:
- A reduced left ventricular ejection fraction (LVEF) below 50% (HFrEF); or
- A preserved LVEF of 50% or more (HFpEF).2
Dr Hayes said individualised, optimal medical therapy is the cornerstone of appropriate clinical management for a patient with heart failure symptoms. While there have been significant advances in drug therapy, Cardiac Resynchronisation devices are now playing an even more critical role in the management of heart failure.
“Device therapy is a good adjunct therapy for eligible patients with heart failure in addition to their optimal medical therapy, he said.
Cardiac Resynchronisation Therapy (CRT) is a state-of-the-art technology that provides biventricular pacing in heart failure patients. This procedure is similar to a standard dual chamber device implantation, with the addition of a third lead that sits on the lateral wall of the left ventricle. Simultaneous stimulation of dyssynchronous ventricles, can help to improve the pump function of the heart. Once the leads are in place, they are connected to a device that sits within a subcutaneous pocket within the anterior chest wall region. Some Cardiac Resynchronisation devices may have an inbuilt defibrillator (also known as a
CRT-D). These devices resynchronise the ventricles and detect and treat life threatening ventricular arrhythmias.
Queensland Cardiovascular Group in partnership with the St Andrew’s War Memorial Hospital pioneered CRT in Queensland in 1998. In 2018, Queensland Cardiovascular Group implanted 600 pacemakers or defibrillators, of which 150 were CRT devices.