Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and today our discussion focuses on how remote monitoring can help patients with heart failure. Joining me is Dr. Kevin Hall. He's an Interventional Cardiologist with Bryan Health. Hi, Dr. Hall, thank you so much for joining us today. So I'd like you to start by telling us what is heart failure and for people that don't understand the difference; they hear heart failure, they've heard heart attack and cardiac arrest. Can you explain the difference between these?

Kevin Hall, MD: Sure, heart failure is a condition where you have a weakening of the heart muscle leading to what most people know as heart failure. Heart failure affects about six and a half million adults in the United States. And it's really one of the leading causes of hospitalization. Essentially it happens when the heart can't pump effectively, and that leads to symptoms such as shortness of breath, swelling, and fatigue. And there are two major types of heart failure. One is when the heart failure has a reduced pump or a reduced ejection fraction. And that's when essentially the heart muscle is too weak to pump blood properly. And then there's another classification of heart failure, it's called heart failure with preserved ejection fraction, that's when the heart does pump normally, but as we age, the heart pump gets stiffer.

As far as heart failure and cardiac arrest, those are different in that heart failure is again where you have a failure of the pump to supply the body with blood to the vital organs. Cardiac arrest is essentially when you have a standstill of that system. So the heart fails to pump. And so the heart is in standstill and that's when we do or employ resuscitative efforts in order to bring back the patient.

Host: Thank you for that. So, are some people more likely to get heart failure than others? Tell us a little bit about risk factors.

Kevin Hall, MD: Sure. So there are some risk factors for the development of coronary artery disease, and those include hypertension, high cholesterol, diabetes is a significant risk factor for the development of coronary artery disease, but essentially when you have coronary artery disease, that can cause complete blockage of the arteries that feed the heart. And when those are blocked, that can lead to heart attack, which is manifested as oftentimes chest pain, chest tightness, as if an elephant is sitting on the chest. Also pain that goes down the left arm, up into the left jaw.

It can be associated with shortness of breath and also signs and symptoms of heart failure.

Host: Tell us a little bit about diagnoses and when you are determining that someone is in heart failure; is this considered a chronic condition now? Is this something that because we're going to be talking about monitoring it, unlike cardiac arrest, which is an emergent, urgent event, this is something that can go on for a while. Yes?

Kevin Hall, MD: That is correct. So, heart failure is and can be a chronic condition. Typically when patients develop heart failure, one, it's identified via a transthoracic echo, also known as a cardiac ultrasound, where we can image the heart, see the outside of the heart, and see the structure and the function of the heart to see if it's pumping adequately or if it's not.

But definitely when we identify heart failure, that's when we really employ those measures to help to recover the heart. A few of those are of course medicines that we know and that have been scientifically shown to improve the pumping function of the heart. We also look at and determine whether or not the heart failure is caused by blockages in the arteries that feed the heart. And in order to do that, we do what we call a heart catheterization. And that's a minimally invasive procedure where we can travel up to the heart, and look at the coronary arteries to see if there are any blockages that are contributing to the patient's heart failure symptoms.

Host: Then let's talk about remote monitoring. As you have patients that you work with, you want to keep track of them. So how to best assess heart function from afar? Tell us a little bit about how remote monitoring devices like CardioMEMS work.

Kevin Hall, MD: Yes, so CardioMEMS is specifically for patients with heart failure. I practice primarily in some areas of rural Nebraska. It's very important that patients in rural areas of the United States, have access to specialized cardiac care, but also, those patients that are suffering from the burden of heart failure, it's really important to remote monitor these patients.

And so that brings in to play, a kind of a game changing device called the CardioMEMS. A CardioMEMS is an implantable device that can continuously measure the pulmonary artery pressures, and it's a key predictor of heart failure exacerbations. Historically, what we've always done for patients with heart failure is we look at their symptoms, so we have them track their weight, we have them look for signs of swelling or shortness of breath.

CardioMEMs detect those changes weeks before symptoms appear, really giving us almost a two to three week lead time. And so that's very important in that, patients aren't having to be readmitted or show up to the hospital because they've become worse or developed major symptoms of heart failure.

Instead, we can remotely monitor them via the CardioMEMS device in order to avoid any costly readmissions. CardioMEMS is a, is a very tiny wireless sensor that helps us as cardiologists for patients with heart failure, really from anywhere. The way I want you to think about it is, it's like a check engine light for the heart. It continuously tracks pressure changes in the lungs, which is really the earliest sign that heart failure is getting worse.

And it really allows us to adjust medicines before symptoms start, such as diuretics that we use primarily for patients with heart failure, in order to unload the extra fluid that leads to the swelling and the shortness of breath. So when we talk about how is this CardioMEMS inserted, it's really small as I said. It's about the size of a paper clip and it weighs less than a gram. So it's incredibly small. And the procedure is a minimally invasive procedure, similar to heart catheterization. And what we do is we insert the sensor into an artery in the lung called the pulmonary artery, which is a blood vessel that leads out into the lungs.

We insert it using a thin tube, also known as a catheter, through either the vein in the groin or either the vein in the neck. And there are no batteries or wires needed, and the sensor is powered wireless by an external reader at home. And the procedure itself takes less than 30 minutes, um, and the patients go home the same day.

Once it's implanted, the sensor continuously measures pressures inside the lungs. And the patients take daily readings by lying on a special pillow shaped device that actually plays some elevator music as it's collecting the data from your, CardioMEMS device. And that information is sent to your doctor in real time, allowing them to catch early signs of fluid buildup before the patient feels or develops any symptoms.

So again, it goes back to being proactive instead of reactive. We're proactive in the sense that, we're able to catch patients before they develop symptoms of shortness of breath, lower extremity swelling, some of the classic signs and symptoms that we see in patients with congestive heart failure, and that lead ultimately to hospital admissions and readmissions.

Host: Isn't technology amazing, Dr. Hall? So as we wrap up, what should someone do if they want more information about heart failure and remote monitoring? What's your best advice for people that may be suffering from heart disease, that may be at risk for heart failure? What would you like them to know?

Kevin Hall, MD: If you or anyone in your family is suffering from heart failure, there is help and technology is advancing at the speed of light. We at Kearney Regional Medical Center would love to take care of you, your family, and we have the latest and greatest technology to really simplify the management of heart failure.

 So definitely if you would like information, an appointment, referral, or consultations, feel free to reach out to us at bryanhealth.org/pvmc. Our number in the office is 308-865-2263 and I can be reached personally at kevin.hall@bryanhealth.org.

Host: Thank you so much, Dr. Hall. You're such an approachable, compassionate doctor. And thank you for joining us and sharing your expertise. And for more information, as Dr. Hall said, please visit bryanhealth.org/ pvmc. And to listen to more podcasts from our experts, you can always visit bryanhealth.org/podcasts. I'm Melanie Cole. Thanks so much for joining us today. That wraps up this episode of Bryan Health Podcast.