More Sexy Ways to Spend Your Health Care Dollars
These new devices however, are permanently implanted and may yield an early warning when a patient with congestive heart failure begins to "decompensate".
Read my thoughts on this here.Dr. Wes, an electrophysiology cardiologist has posted on two remarkable implantable devices. They continually monitor the heart's pulmonary arterial and left atrial pressures. Normally, continuous monitoring of these parameters requires the insertion of a pulmonary artery catheter in the ICU. The patient doesn't get to take this invasive equipment home with them (fortunately).
These new devices however, are permanently implanted and may yield an early warning when a patient with congestive heart failure begins to "decompensate". Such a warning may allow the patient's doctor to adjust his medications to reflect these alterations in cardiac function. This is analogous to asthmatics measuring their lung function with portable peak flow meters and adjusting their inhaler frequencies accordingly.
Of course the difference is that peak flow meters cost hardly anything. They're disposables that we give away in the E.D. all the time. The devices mentioned by Dr. Wes will undoubtedly cost a zillion dollars each and will certainly be associated with nasty complications.
It may seem quaint but there was once a time when we used to assess patients' cardiac function by listening to their hearts and lungs and looking at their feet. We even trusted patients to adjust their own meds by actually weighing themselves each morning!
Now we'll have these gadgets. Of course as Dr Wes points out, there won't be a market for them unless they can be shown to add significant benefit to these more arcane methods of assessment. Randomized clinical trials are no doubt on the way to see if they improve cardiac outcomes (MI, death, cardiovascular hospitalization).
Here's a little prediction: these upcoming studies will compare the use of the devices with "usual care" (physician assessments). They will NOT be going head-to-head against "that other" early warning system: serial monitoring of serum brain natriuretic peptide (BNP). BNP is a relatively cheap blood test that also appears to provide clinical information that augments that of the physical exam. Serial monitoring reduced heart failure-related death or hospitalization compared to usual care in some small studies and at least one big study (see here).
Why would the device manufacturers go looking for trouble by comparing themselves to another technology that also works and that is almost certainly cheaper?
I don't think I'll be pulling out my Vanguard S&P 500 cash for the these particular investment opportunities.