Closer follow-up urged for heart patients
Panel focuses on monitors and implants
MILWAUKEE - People with implanted heart devices need closer follow-up care, an international panel of heart specialists recommended yesterday in the first guidelines for monitoring this rapidly growing group of patients.
Nearly 2 million people worldwide have pacemakers, defibrillators, or other machines to help their hearts beat faster, slower, or more regularly.
For years, attention focused on who should get these devices and whether insurance should pay. Now doctors are facing the daunting task of making sure that they keep working and that patients hear about safety issues, such as the big recalls that have shaken the industry in recent years.
The guidelines spell out who should do what to ensure good care. They tackle ethical dilemmas, such as when to turn off a device and let a patient die. This is aimed at preventing horror stories like those of dying cancer patients whose defibrillators continue to shock their failing hearts back to life.
The guidelines also endorse new wireless technology that lets doctors check devices remotely while a patient is at home, an emerging standard of care.
"To some people, technology is scary, and they would rather talk face to face," said the Cleveland Clinic's Dr. Bruce Wilkoff. But to others, home monitoring saves time and money, gives peace of mind, and avoids trips to the hospital, he said.
Wilkoff led the panel that wrote the guidelines. They were announced yesterday in San Francisco at a meeting of the Heart Rhythm Society, doctors who treat heartbeat problems.
At the meeting, Cleveland Clinic researchers reported results of a five-year experiment with home monitoring. Remote checkups rose dramatically, from 94 people at the start of the study to more than 5,000 by its end, without a big burden to the clinic's staff.
"It's a whole new way of being able to treat patients," said Dr. Kenneth Ellenbogen, a heart device specialist at Virginia Commonwealth University and a spokesman for the American Heart Association. "It is becoming standard with all new defibrillators and in the next couple of years will become standard with all new pacemakers. It is going to provide us with data that we've never, ever had before."
Robert Print, a 64-year-old heart attack survivor from suburban Cleveland, agreed to try it.
"It's quite amazing, a very nice convenience. All you have to do is dial the phone, put the monitor over your device, and it's being transmitted over the airwaves," he said.
Devices have not just grown more common, but they have increased in complexity and do not just run on "autopilot" without regular maintenance, doctors said.
Pacemakers do their job with little notice by patients, but a defibrillator repeatedly and even painfully shocking a patient's heart can erode quality at the end of life and prolong suffering. Deactivating a defibrillator can be seen as similar to following "do not resuscitate" orders in certain circumstances, the guidelines say.
"The most important thing is that the patient understands what's going on and it's their decision," Wilkoff said.
"There are times where it's appropriate and times when it's not appropriate."
Today, a broad coalition of heart groups will update longstanding guidelines on who should get various heart devices and for what conditions.
