Emory's heart failure toolbox
Javed Butler
Heart failure is a chronic, progressive disease that gobbles up a person’s energy and breath, leaving them gasping, thirsty, and swollen with water retention.
When a simple trip from bed to bathroom becomes a walk across a desert, their only hope may be a heart transplant.
“We have gotten better at keeping patients with heart failure alive longer,” says Javed Butler (right), director of heart failure research at Emory Healthcare. “Mortality has consistently gone down, although prevalence is increasing. But in terms of quality of life, when a person spends years hardly able to walk across the room, that is not a successful outcome.”
Indeed, heart failure now afflicts nearly 5.7 million adults in the United States. Incidence is steadily rising, with about 670,000 new cases reported every year.
But because heart failure is a syndrome that springs from a mishmash of different diseases, a treatment is not easy to come by. Simply keeping symptoms under control is the aim of most treatment plans. Prescription beta blockers keep blood pressure under control, a low-sodium diet prevents water retention and lung congestion, and exercise maintains the heart’s strength.
However, to truly lessen the burden of heart disease, says Butler, prevention and early intervention are necessary. As deputy chief science adviser for the American Heart Association, Butler and others recently created a statistical model based on patient data to identify those at a high risk for heart failure. Butler hopes the risk tool will help pinpoint people at risk for heart failure despite its elusive causes.
He also has developed the infrastructure for a comprehensive study of patients with heart failure. A dozen researchers from across several disciplines already have begun collecting baseline data on patients at Emory hospitals and Grady Memorial Hospital.
Meanwhile the number of heart failure patients at Emory University Hospital (EUH) and EUH Midtown has ballooned so much that physicians have developed new ways to care for patients involving remote monitoring, says Andrew Smith, medical director of Heart Failure and Transplantation.
Remote monitoring saves patients time and gives doctors more information about the patient’s condition. “About 85% of heart failure patients admitted to the hospital have salt and water retention,” says Smith. “Remotely monitoring our patients’ symptoms helps reduce hospitalizations.”
A telemonitoring system sends the clinic a patient’s weight via a cell phone every time the patient steps on a scale. Using an automated phone system, patients call a central number daily, enter their weight, and answer a list of “yes” or “no” questions. A nurse practitioner reviews the calls, and if she determines that weight gain is too rapid (more than 4 lbs. a day), she has the patient come in.
Surgically implanted pacemaker defibrillators help patients whose heart failure is complicated by heart arrhythmias. Sensor technology detects abnormal heartbeats, and the defibrillators pace or shock the heart back into rhythm.
One vendor even offers Bluetooth technology so that when patients step on a scale, the information goes to the defibrillator. At night, the information is logged into a central computer system, and the Emory heart failure team can track weight increases to spot a problem. Another remote device measures electrical signals across the lung, indicating fluid retention.
Smith is anticipating the completion of clinical trials now under way at EUH and EUH Midtown for several additional investigational devices.
Ultimately, the goal of Smith and Butler is to keep heart failure patients healthy. No one lives forever, says Butler. But keeping heart disease risk factors at bay can help people make the most of their later years. —Valerie Gregg
