From left: Dr Wendy Chan, Associate Professor Chris Charles, Associate Professor Richard Troughton, Dr Iain Melton, Associate Professor Miriam Rademaker.
“Go to your bosom; Knock there, and ask your heart what it doth know ...”
~ William Shakespeare (1564-1616).
Researchers from the University of Otago, Christchurch, are giving new meaning to these words from the great bard. They have implanted the world's first heart monitor, which gives daily updates of pressure changes in chronic cardiac patients.
Early clinical results are impressive. They show that treatment guided by daily monitoring from these sensors may offer an advantage over standard care, based on assessment of patient weight and clinical status.
“This is a significant advance in the monitoring of heart failure and it allows patients to accurately check pressures in the heart on a daily basis using a hand-held computer. This information can then be used to guide medication and dosing levels,” says lead investigator Associate Professor Richard Troughton.
“In the past, monitoring of chronic heart failure has relied on less accurate tools, such as weight. Medication doses tend to be adjusted infrequently – usually at the time of hospital admission or clinic visits – and there has been no mechanism to guide daily dosing of medications,” Troughton says.
The technically innovative trial involves placing a sensor in the left atrium of the heart. This allows patients and doctors to get accurate daily observations of left atrial pressure, which is a key determinant of symptoms in heart failure.
In a study published this year in the American Heart Association journal Circulation, the new monitoring device was associated with a 67 per cent reduction in the frequency of patients' elevated left atrial pressure readings and a reduction in hospitalisation for heart failure. In some patients, the daily remote monitoring identified lifethreatening changes.
Patients from Christchurch, Auckland, Australia and the US took part in the trials of the device. In New Zealand, University of Otago, Christchurch, researchers teamed up with clinicians from Christchurch Hospital.
The Christchurch team led the study of this novel device worldwide and implanted the first devices. It included Troughton, Associate Professor Miriam Rademaker, Associate Professor Chris Charles, Dr Iain Melton, Dr Ian Crozier, Dr Jay Ritzema and Dr Wendy Chan.
Troughton says one of the reasons for the study's positive results was that patients liked having a greater sense of control over their condition.
The remote sensor device is now being tested further in a large international multicentre study.
Funding
- Health Research Council
- National Heart Foundation
- St Jude Medical Inc