by Matt Batcheldor
In 2018, Ronnie Kreis began to develop severe heart failure. After being hospitalized multiple times that year near his home in Oliver Springs in East Tennessee, he was told that nothing else could be done.
“They told me I was very ill and that I had probably a 40% chance to live a year,” he said.
Kreis traveled to Vanderbilt Heart and Vascular Institute (VHVI) to see if he could have an investigational valve procedure. There, the doctors recognized that his problem instead was the high pressures in his heart and lungs. As with many medical problems, he was not a candidate for a transplant or a ventricular assist device.
He was hospitalized to undergo tailoring of medications at high doses to lower the pressures in his heart and lungs. This regimen immediately improved his breathing and appetite, but it was hard to adjust as he lived too far away to return often.
To follow him at home, a device the size of a paper clip was implanted in his chest. The device, called the CardioMEMS HF System, monitors the pressure in his pulmonary artery. Every day or two, Kreis and dozens of others in VHVI’s CardioMEMS program lie down for a few minutes on a special pillow connected to a smartphone or computer to transmit information from the device to the nurses at Vanderbilt.
“This tiny device allows patients to be monitored remotely, allowing their care team to catch heart failure problems early. Patients describe better quality of life and require fewer in-person appointments,” said Sandip Zalawadiya, MBBS, assistant professor of Medicine and the physician champion for the CardioMEMS program at VHVI, who implanted the device in Kreis.
Heart failure hospitalizations decreased by 33% in the original clinical trial. The benefit was shown to be even greater in a study of 1,200 patients in real-world practice, led by Vanderbilt faculty. Those results will be published in August. That showed a 57% decrease in heart failure hospitalizations and 27% reduction in all-cause hospitalizations, said Lynne Stevenson, MD, Lisa M. Jacobson Professor of Cardiovascular Medicine, Kreis’ cardiologist and one of the world’s leading experts in CardioMEMS technology.
Kreis’s high pulmonary pressures have been decreased by half compared to a year ago. Studies have shown that pulmonary artery pressures measured by the device are directly linked to the health of heart failure patients, said Jessica Bowman Williams, BSN, RN, CCRN, assistant nurse manager for VHVI and advanced heart failure program leader champion for the CardioMEMS program.
“One out of every five patients will die within the first five years of diagnosis of heart failure,” Williams said. “There is evidence that heart failure admission increases the patient’s chances of mortality. If we’re reducing those readmissions, we also reduce morbidity and mortality, as the most recent studies of CardioMEMS have shown.”
Kreis recently turned 70, a milestone he attributes in no small part to the device, his individualized prescription regimen and his medical team at VHVI. His friends are amazed to see him now. “I’ve done so well I think it kind of shocked them.”
“The CardioMEMS program at Vanderbilt is very comprehensive and is aimed at delivering health care in the most efficient and effective manner,” Zalawadiya said. “We are also proud to have participated in all major clinical trials of this device; currently, we are enrolling patients in the national GUIDE-HF clinical trial.”
VHVI is a fast-growing center for CardioMEMS, implanting 20 people in the last 18 months, more than double the number implanted in the previous five years, when the device was approved by the FDA. Williams said that is the result of a multidisciplinary team that was formed to determine good candidates for the device.
“The thing that I’m most proud of for this project is how multidisciplinary and collaborative it has been. It’s gone across specialties and disciplines,” Williams said. “I think it has really elevated our nursing team.”
Stevenson and Zalawadiya credit Williams’ leadership with making this program a success, together with their team, including Chelsey Roberts, RN; Nicole Dellise, DNP, FNP-BC, CHFN and Judy Francescon, RN, who have designed the pathway for patients who need the device. Other team members are Amy Howard, ACNP-BC, CHFN; Linda Howerton, MSN, ACNP-BC, CCRN, CHFN; Leslie Cornell, RN (CardioMEMS Research Nurse Specialist) and JoAnn Lindenfeld, MD, professor of Medicine and director of the section of Heart Failure and Transplantation.
“This technology provides us the opportunity to treat our patients proactively, before symptoms of fluid congestion occur,” Dellise said. “Not only are we able to lessen the heart failure symptom burden, but also offer our patients a sense of security knowing our team is monitoring their CardioMEMS device.”
The implantation of the device takes place during a right heart catheterization, a common procedure that most heart failure patients have already experienced. Implanting the device is quick and painless and is performed in about 30 minutes by Zalawadiya and Mark Glazer, MD, assistant professor of Medicine. Patients are asked to take just a day off work and go home the same day.
Kreis says the device gives him peace of mind that his heart is being monitored remotely. He can take his pillow on trips allowing him to check in from wherever he goes. His device has also allowed him to stay safely at home during the COVID-19 pandemic instead of his clinic visits to Vanderbilt, sparing him two 6-hour round trips and two overnight hotel stays in Nashville.
“It gives you a good feeling that somebody knows what’s going on day by day,” he said. “I have great praise for that staff. The results speak for themselves.”