Improving adherence to medications for heart failure: Medtronic says their CRT does it

Despite relatively few strong research studies supporting methodologies for improving adherence to medications for patients with heart failure, Medtronic's recent press release suggests their cardiac resynchronization therapy (CRT) implants might do the trick.

Medtronic accounced results of a retrospective analysis of administrative claims data of more than 4,500 patients with heart failure at the 2016 Heart Failure Society of America Scientific Meeting, Monday.

The analysis found that the number of patients "fully compliant" to a regimen of guideline-recommended medications "nearly doubled" at twelve months following CRT implants compared to those who did not receive implants.

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Broader CMR or SPECT imaging reduces unnecessary angiography

Results from the CE-MARC 2 trial, announced today at the European Society of Cardiology (ESC) Congress, suggest that unnecessary angiography could be significantly reduced by favoring noninvasive cardiovascular magnetic resonance (CMR) imaging or single photon emission computed tomography (SPECT) to initially investigate patients with suspected coronary artery disease (CAD).

These findings could have an "important impact on referral rates for invasive coronary angiography," says the ESC press release.

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Future of cardiology: personalized care through genetics?

Genetic arrhythmia programs are paving new roads for personalized cardiac care—from preventing unnecessary cautionary testing or treatment to improving screening.

Melvin Scheinman, MD—the first person to perform catheter ablation for arrhythmia in a human patient, now chief of the Comprehensive Genetic Arrhythmia Program at the University of California, San Francisco—believes genetic testing will lead to the "ultimate form of personalized medicine," writes Gregory A. Freeman of HealthLeaders Magazine.

"If you examine the genetic background of a patient, you may be able to identify sensitivity to specific drugs, propensity for developing some very serious heart disorders, and at the same time rule out those same things for other people," said Scheinman to HealthLeaders.

"That is really what personalized medicine is all about—delivering the right care to the patient because you truly understand the patient and don't have to treat him or her as just a member of a group with certain statistical risks."

A proliferation of genetic arrhythmia programs "across the country" have been introducing new, measured responses to a sudden cardiac death in the family—preventive healthcare for some, but not all family members.

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Taking Telemetry Out of the Hospital Improves Outcomes, Reduces Alarm Fatigue

A new study suggests the use of an off-site cardiac telemetry central monitoring unit (CMU) could improve telemetry alarms for non-intensive care unit patients and reduce the number of monitored patients—without increasing cardiopulmonary arrest events.

The study, published August 2 in the Journal of the American Medical Association, studied all non-intensive care unit patients at Cleveland Clinic and three other regional hospitals over a period of thirteen months. An off-site CMU applied "standardized cardiac telemetry" for 99,048 patients during that time.

The Data

Among the study's population, emergency response team (ERT) activation occurred for 3,243 patients. 979 of those patients had rhythm or rate changes occurring up to one hour prior to the ERT activation. The CMU detected and provided accurate notification for 772—or 79 percent—of those events, according to the study's abstract.

For 105 patients, the CMU provided "discretionary direct ERT notification" for events requiring urgent clinical intervention, reads the abstract. Slightly more than one in four of those patients went on to experience cardiopulmonary arrest events—27 patients, or 26 percent. Return to circulation was achieved in 25 of those patients, or 93 percent.

Telemetry standardization also reduced the number of patients monitored by 15.5 percent per week through eliminating low-risk patients.

How the Central Monitoring Unit Works

The study's model used one monitoring technician to provide continuous cardiac monitoring for up to 48 patients, providing blood pressure, pulse oximetry, and respiratory rate notifications on request, according to the JAMA media release. A lead technician also provided oversight and supervision for real-time rhythm interpretation.

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