The huge burden of heart failure disease

After discharge from a Heart Failure hospitalization, patients are at an unacceptably high risk of recurrent hospitalizations or death.
  • One major origin of post-discharge events is the residual patient congestion that is not optimally alleviated at discharge.1
  • In fact, many patients leave the hospital before their diuretic therapy is optimized.
  • Another important fact is that patients are discharged before lifesaving renin-angiotensin antagonists and mineralocorticoid receptor antagonists could be optimized to reach the highest tolerable doses.2

Guidelines recommend optimizing pharmacotherapy to improve outcomes for patients with heart failure

(grade 1, level of evidence A)
Optimizing medications belonging to the RAAS inhibitor class (ACE-Is, ARBs and MRAs) have been proven to improve survival and reduce hospitalizations in patients with heart failure.2 In addition, optimizing diuretics reduces volume overload, eases the signs and symptoms of pulmonary congestion and keeps patients out of hospital.2

Then why are these life-saving medications often under-utilized and under-dosed?

The concerns for raising serum potassium levels, worsening renal function, or inadequate decongestion limit the way these medicines are utilized and dosed.3 Complicating the management of patients with heart failure is the fact that physicians do not have simple, patient-friendly tools to easily keep track of these issues with their patients at home.

So, what is the expressed need here?

We know that optimizing care through disease management programs improves outcomes in patients with heart failure. Up until recently, the focus has been on monitoring pulmonary congestion so that physicians can optimize diuretic doses and reduce admissions.4

But this is only part of the solution … We also need to be monitoring serum potassium and renal function so that physicians can optimize not just the dose of a diuretic, but also optimize doses of ACE-I, ARB or MRA. With such a complete view of the status of their HF patient overtime, physicians would feel safe and confident so as to optimize medication precisely to each patient status.

  1.  Coiro S et al, Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail 2015;17:1172–1181.
  2.  2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, European Heart Journal (2016) 37, 2129–2200
  3.  Epstein M et al, Evaluation of the gap between guidelines and the utilization of RAAS Inhibitors; Am J of Managed Care, 2015, 21, S212-S220
  4.  Abraham W et al, Wireless pulmonary artery hemodynamic monitoring in chronic heart failure: a randomized controlled trial; Lancet 2011; 377: 658–66

What if we could ...

If there was a way to reliably, simply, and cost-effectively monitor serum potassium, renal function, and the degree of congestion in our heart failure patients at home, could we then optimize the use of these life-saving medicines? With a more comprehensive approach like this, we may be able to reduce not just hospital readmissions, but we may also be able to improve the quality of life and survival of HF patients.