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LI heart disease patients seek relief in medical innovations

Barry Weitz poses for a portrait at his

Barry Weitz poses for a portrait at his Port Washington home Tuesday, September 2, 2014. Weitz has been implanted with a first-of-its-kind device that helps mitigate problems associated with a heart failure condition. Credit: Barry Sloan

Barry Weitz was in and out of the hospital throughout the year with alarming episodes of shortness of breath, a key symptom of heart failure.

To give his Long Island doctors a better handle on his condition, they recommended a newly approved implant that monitors cardiac activity while resting on a pillow.

The technology, one of a burgeoning number of advances to address heart failure, comes as doctors are testing new drug strategies in an effort to lower the death rate for one of the most common killers of older adults.

An experimental compound announced in Barcelona last week at a cardiology meeting promises to lower the death rate by about 20 percent.

Weitz, 68, a retired teacher and principal who lives in Port Washington, recalls days fraught with worry because of heart failure's unpredictable and debilitating course.

"I would get up [in the morning] and I couldn't breathe," said Weitz, who is the fourth person in the country to receive the implant. "It was very scary. It would last half a minute sometimes; other times it was a minute. But it feels like it's much longer when you're experiencing it."

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Worse, Weitz suffered a blackout, another symptom of the condition that frightened him.

Diagnosed in July 2013, Weitz estimates being hospitalized at least a half-dozen times in about a year.

Heart failure -- also known as congestive heart failure -- is a condition in which the heart can't pump enough blood to supply the body's requirements.

For some people this means the heart can't fill with enough blood. For others, it simply can't pump to the entire body with enough force. Doctors say some people are stricken with a type of heart failure that encompasses both problems.

Having heart failure doesn't mean a patient's heart is on the verge of stopping, but the diagnosis does translate into a poor quality of life, and for many, death within five years of diagnosis.

 

Watching his diet, and data

Dr. Stanley Katz, senior vice president for cardiovascular services at North Shore University Hospital in Manhasset, and Weitz's doctor, said one of his patient's key problems was fluid retention as a result of extreme salt sensitivity, which is common among people with heart failure.

"He retains water easily," Katz said. "So I managed his heart failure with diuretics. I would also have him weigh himself every day. And when he would notice a weight gain he would call me and I would adjust his diuretic."

Weitz has focused on weight loss and dramatically curtailing salt intake. By limiting salt in his diet, he was able to lose 29 pounds of water weight in 30 days, he said.

Katz said keeping an eye on salt consumption was important because it did not bode well for Weitz in the past. "He would go to a diner and have pea soup and that would tip him over the edge," Katz said.

The doctor and his colleagues recommended a device approved in May by the U.S. Food and Drug Administration to help better manage patients like Weitz.

The new system hails from the gee-whiz world of bit processors and sensing technology by recognizing changes in fluid pressure days before patients are aware of it themselves.

Known as CardioMEMS, the system consists of a small dime-sized sensor implant placed in Weitz's pulmonary artery in August.

The system, a product of St. Jude Medical Inc. in St. Paul, Minnesota, includes a special pillow arrayed with processors that recognize data sent from the sensor as Weitz rests on it.

The high-tech pillow instantly sends the information to a small base unit next to Weitz's bed. The daily findings are transmitted to doctors at North Shore. Studies suggest the system helps cut hospitalizations by 37 percent.

 

A costly condition

Dr. Nathaniel Reichek, director of cardiac research at St. Francis Hospital in Flower Hill, said monitoring provides patients with a sense of security and doctors with precise information.

He added that in recent months there has been a welcome upsurge in developments for heart failure, a disorder that affects an estimated 5.1 million people nationwide.

"It's a huge problem by any measure in that it is the single greatest cause of morbidity and mortality in the rapidly growing elderly population, and it also is the most common reason for hospitalizations in the elderly, so it causes a lot of suffering," Reichek said.

The condition is also one of the costliest in the nation at $32 billion annually.

"In the last few years there have been a number of new agents under study," Reichek said, referring to drugs that offer a paradigm shift in their approach to addressing the disorder by helping the heart function more effectively.

St. Francis is a test site for the experimental Novartis heart failure drug, LCS696, reported last week in Spain by principal U.S. investigators overseeing the clinical study of more than 8,000 patients. There are six patients in the drug study at St. Francis.

The hospital also is testing another experimental Novartis heart failure medication, Serelaxin, designed to address multiple concerns specific to heart failure.

 

MONITORING HEART FAILURE

 

The CardioMEMS wireless system is designed for patients with New York Heart Association Class III heart failure. Stage III is considered moderate, which means people are comfortable at rest, but ordinary daily activity causes fatigue. This is how the system works:

1. A miniature rectangular-shaped sensor the size of a dime is placed in the pulmonary artery to monitor fluid pressure around the clock.

2. The sensor is inserted in a hospital catheterization laboratory through a minimally invasive procedure in which the device is mounted on a catheter, which is inserted through the groin and guided to its destination in the pulmonary artery.

3. A special pillow arrayed with processors detects daily fluid pressure in the pulmonary artery when patients rest on it for a few minutes.

4. Data from the pillow are relayed to a small base station, which has built-in voice technology to tell the patient whether he or she is properly positioned on the pillow. The unit is usually next to a patient's bed at home. That unit transmits the information to the doctor's computer.

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