Heart failure—a condition in which the heart doesn’t pump adequate amounts of blood throughout the body—results in more than one million hospitalizations in the U.S. every year. That’s approximately 3,000 every day. A quarter of those patients—about 800—will be readmitted within 30 days, and half of those patients will die within five years.
Imagine how many lives could be saved if we could predict heart failure far enough in advance to take preventative action. A team of researchers and engineers from Boston Scientific, a medical device company based in Marlborough, Mass., set out to see if technology could predict a patient’s impending heart failure—and send an alert to their physician weeks before an episode occurs.
Historically, heart failure episodes are difficult to predict before it’s too late. Regular visits to the doctor provide snapshots of how patients are doing at a point in time; unfortunately, those snapshots don’t tell doctors what might happen days and weeks down the line. Often, patients diagnosed with heart failure go through long periods of relative stability punctuated by quick declines that manifest as episodes of sudden worsening—what doctors call “acute decompensation.”
“These are periods when, all of a sudden, patients may end up needing to be admitted to the hospital,” says Dr. Kenneth Stein, senior vice president and chief medical officer, Rhythm Management and Global Health Policy at Boston Scientific. “It is one of the most common causes of hospitalization in the United States.”
PREDICTIVE AND ACTIONABLE
Using information from a number of continuous data-stream sensors in implantable cardiac devices, Boston Scientific developed the HeartLogic Heart Failure Diagnostic, which can predict heart failure events on average 34 days before they happen. The algorithm alerts doctors of worsening conditions, allowing for earlier intervention and preventative action.
“We had two design imperatives in creating HeartLogic,” Dr. Stein says. “The first was to deliver personalized, predictive care. The second was translating data into action.”
Stein draws an analogy to the evolution of auto maintenance. At first, mechanics mostly offered condition-based maintenance: If your car broke, they would fix it. Then, they began offering preventive maintenance, such as regular oil changes and scheduled tune-ups. These days, many cars provide predictive maintenance in the form of sensors that alert drivers to visit the shop before something goes wrong with the engine. The HeartLogic Diagnostic provides a similar service: physicians receive alerts about a patient’s worsening heart failure before the damage is done.
But it’s the actionable component that sets it apart. The diagnostic sensors within the device collect information in five key metrics: heart rate, respiration, thoracic impedance (which measures whether fluid is accumulating in the lungs), patient activity levels, and heart sounds. Other devices exist that monitor one or two of these metrics, but the HeartLogic Diagnostic is unique in that it synthesizes many data points.
Rather than send doctors individual data points as they are collected, the proprietary algorithm combines them and presents the data in a single, easy-to-analyze composite index. Doctors are only alerted when the index crosses a threshold that indicates potential worsening. In an age when data exists for practically every detail of our lives, the HeartLogic Diagnostic cuts through the noise to deliver only the most relevant, actionable information.
A GAME-CHANGING TECHNOLOGY
Dr. Ugochukwu Egolum and his fellow cardiologists at the Northeast Georgia Health system have been using the HeartLogic Diagnostic with their patients. “For us,” he says, “it’s been a real game changer.”
Near the beginning of the pandemic, Dr. Egolum saw a COVID-19 patient with a history of heart failure. The patient, who had recently received an implantable device with the HeartLogic Diagnostic activated, was diagnosed, treated, and discharged. At home, he continued to experience lingering COVID-19 symptoms, particularly fatigue and shortness of breath. But since those symptoms can mimic heart failure symptoms, he wanted to be sure of the underlying cause and contacted Dr. Egolum.
Dr. Egolum saw there were no significant changes in any of the metrics since the patient contracted COVID-19 and determined the patient was not at risk for an acute heart failure event. The patient could relax, take his medicine, and work from home, knowing that his doctor would receive an alert if anything were to change.
If the HeartLogic Diagnostic had detected worsening heart failure symptoms in his COVID-19 patient, Dr. Egolum would have contacted him immediately. Sometimes all that’s needed is a reminder to take prescribed medications, while, other times, a visit to the doctor may be necessary to determine other possible solutions. Above all, the goal is to avoid significant cardiac events and the more intensive treatments they typically demand.
A BOON FOR PATIENTS AND DOCTORS ALIKE
The new technology has huge implications for healthcare efficiency. “On the one hand, HeartLogic allows us to focus our resources on the patients who most need us,” Dr. Egolum says. “On the other, it allows us to reduce the number of clinical interactions with patients who are doing well.”
That means fewer hospitalizations and more peace of mind for patients with heart failure. Many may be able to check in with their doctors via regular at-home televisits. In the era of COVID-19, when healthcare providers are overburdened and hospital space is limited, having the flexibility to manage a patient’s care virtually and safely is a relief for patients and their providers.
No one wants to get the news that they have heart failure. “It’s one of those awful diagnoses that can be devastating to hear,” Dr. Stein says. But millions of people continue to lead rich, full lives after a heart failure diagnosis. As more patients realize the benefits of personalized, predictive monitoring technology, a heart failure diagnosis may begin to sound less scary and more manageable for patients and doctors alike.