Many Changes Bring the Hope of Better Care for Heart Failure

In my last blog, I discussed our abysmal record in treating heart failure.  A great deal of effort is being directed to this health care challenge as it represents a great economic opportunity.  The opportunity is on both sides of the equation with biomedical and drug companies on one side, hospitals and provider organizations on the other.

Medicare is relaxing some of the antitrust and Stark rules that govern the interaction between hospitals and doctors to allow for pilot projects that allow the division of money that is saved between participants.  This topic alone is the subject of many very large books and I can not do it justice. 

In brief, the projects allow for the joining of divergent groups to participate in clinical practice that is accountable for outcomes.  In other words, you just can’t save money by denying care; you have to save money by doing it better.  This process will allow for innovation to flourish, and let’s face it, innovation does better if there is reward at the end of it.  All sides will be winners the hospitals will not lose as much money, practitioners will be compensated and patients won’t end up in the endless and damaging spiral of repeated admissions and hopefully will achieve a better quality of life.

Some of the biomedical companies have provided unique tools for our use and are now in the approval phase of them.  The approval of these devices is interesting in itself.  Since the devices do what they say they do i.e. measure something and that is not at issue the FDA requires that the “measuring” has some clinical benefit.  To that end studies have been set up to determine whether by measuring “something” patients can obtain better treatment, have a better quality of life, and stay out of the hospital.

Now we as practitioners use a patient’s daily weight as a measure of whether a patient is stable in their condition.  The increase in a patient’s weight signals a worsening of their condition and the need for intervention.  That seemed pretty reasonable until it was shown that the weight gain comes 10-14 days after the worsening of the condition begins, so not only is it delayed but almost to late when it arrives.

In my next series of blogs I will detail the innovation that the medical industry is bringing to the problem.

Tags: Heart Failure, Medicare
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Health Care Reform and the Treatment of Heart Disease

There have been endless hours of discussion regarding “Health Care Reform.”  I once heard that you didn’t want to see sausage being made, but it sure tasted good.  That certainly holds true for our process in Washington.  Unfortunately, what the Congress and Senate are arguing about is not “Health Care Reform” but insurance reform and how we pay for our medical care, which as it is often pointed out, is very technical and expensive but it often doesn’t accomplish much.

Recently this phenomenon was again pointed out to me in an unsettling way.  An article was published in Circulation: Heart Failure on November 10, 2009, detailing our United States failure in the treatment of heart failure.

This article detailed the startling fact that 25% of heart failure patients discharged were back in the hospital within 30 days.  This was not occurring in isolated areas but was the figure across Medicare.  Since Medicare recipients have insurance and drugs as well as ancillary care, the figure for non Medicare patients is likely higher.

Further, this readmission rate figure is consistent from year to year.  It occurred in each of the years from 2004 to 2006.  So not only are we doing a poor job; but we don’t even know how to fix it.  This was documented by the statistic that half of the hospitals in the United States had risk standardized readmission rates within 1.5% of one another indicating that none of them had a better idea.

Part of the problem is that our present system rewards poor performance and stagnation.  I do not mean that doctors don’t try to make a patient truly better from their chronic condition but if they “fail” and the patient is readmitted, they get paid again.  If you had a car which didn’t work, how many times would you take it back to the same place to try again?

Although the problem can be identified in a blog, an entire book could be written on this issue.  This is a major issue as it accounts for the major expense to the Medicare system.  People do not realize that the mortality of patients with the diagnosis of congestive heart failure over five years is close to 100%.  As heart disease is the leading cause of death in the United States, the amount of money being spent is truly astounding.

This is a topic I will blog about continuously this year.  The medical system is moving on many fronts to confront and solve this problem and to define systems that work and can be put into place.  Technology is now available to help and I will detail much of this in coming blogs.

Tags: Health Care Reform, Heart Failure
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Getting a Leg Up on Heart Failure

Heart failure has reached epidemic proportions in the United States owing to our aging population and the advances in treating myocardial infarctions.  Over 5 million people carry the diagnosis and 550,000 new cases a year occur.  In 2001, there were nearly 1 million hospital discharges.

We have multiple therapeutic options which include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, cardiac resynchronization, diuretics and since the 1700s, digitalis.  Now the latest innovation, stem cell injections.

Bioheart is a biotech company located in Sunrise, Florida.  They have developed a process to find and grow skeletal muscle stem cells.  We do not yet have a process to biopsy and grow cardiac stem cells.  There are several very early stage studies in Europe with progenitor cardiac stem cells but they are still in pilot stage.  Bioheart’s Marvel study is the third and final step to FDA approval of these cells for the treatment of congestive heart failure.  A pilot study and a safety study showed that this treatment was safe with a robust trend to effective.  In fact, the first 20 patients of the third study - of which three are from our site - have been studied and also found to have a robust effect.

The process involves taking a biopsy from the leg muscle of patients.  This is then sent to Bioheart and processed to find the 6-8 fibroblast stem cells in the biopsy specimen.  These cells are then grown out and in 14-21 days become billions of cells.  These cells are then given to me to inject in the heart after NOGA mapping shows me the appropriate place. See the blogs of June 22 and / or 29 for details of the NOGA procedure.

We are proud to be the only team in South Florida doing this important work.  The study will open for enrollment again in the Fall and we look forward to helping our patients with this technique.  Please feel free to contact us for more information at 954-229-8400.

Tags: Bioheart, Enrollment, Heart Failure, Marvel, NOGA, Stem cell injections, Therapeutic options
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