Heart-Failure Treatment by Device
Technological breakthroughs are changing the course of heart-failure treatment -- but doubts remain about how many people will benefit in the near future.
Left Ventricular Assist Devices (LVADs) continued...
Eric A. Rose, MD, chairman of the department of surgery at Columbia University College of Physicians and Surgeons and surgeon-in-chief at Columbia Presbyterian Medical Center, tested the effectiveness of the LVAD in people with end-stage heart failure -- 68 had LVADs implanted and 61 were given standard medical care. After two years, the LVADs were shown to be strikingly effective, reducing deaths by 47%.
Potentially, one of the most promising aspects of LVADs is that they may actually rest the heart, allowing it to recover; in such cases, the device can be removed.
"In a lot of ways, it's not unexpected," says John Watson, MD, who was a project officer for the LVAD study. "One of the original ways of treating heart failure was with bed rest, and some people recovered. It's like putting a bone in a cast, giving the heart time to heal."
However, Rose is cautious. "I think that the effect has been overrated," he says. "I've seen people who can have their LVADs removed successfully, but I've seen others who have had their hearts fail again afterwards. I think that success is the exception rather than the rule, and it all depends on the mechanism of heart failure in the first place."
Rose does believe that LVADs technology for heart-failure treatment will improve and become more widely used with time.
"I think that LVAD usage will be analogous to kidney dialysis," says Rose. "When dialysis was first introduced in the 1960s, it was only viewed as a bridge to kidney transplantation. But as the technology developed, it's gotten to the point where people can live on dialysis for decades."
Implants for Everyone?
According to many, the biggest obstacle to the widespread use of devices in heart-failure treatment is its costs. Drug treatment is definitely cheaper, and for the short term, most people with heart failure are likely to be treated with drugs and not devices. However, costs for devices will probably drop, according to experts.
"If you have something this effective in this large a market with more than one company making the devices," says Bristow, "the costs are going to come down."
Many experts observe that medical breakthroughs are always followed by concerns about costs. "People said the same thing about coronary bypass surgery, pacemakers, and defibrillators," says Watson, director of the clinical and molecular medicine program in the National Heart, Lung and Blood Institute's Division of Heart and Vascular Diseases. "By cost-effectiveness analysis, pacemakers and implantable defibrillators show that they save money in the long run."
As a society, we may also have a blinkered view when it comes to evaluating medical costs. "We have an inappropriate way of looking at the price tags for these devices," says Jay N. Cohn, MD, from the cardiovascular division in the department of medicine at the University of Minnesota Medical School. "Yes, an LVAD might cost a lot, but saving a single life with an airbag costs $25 million. That's money from taxes that we all pay to put airbags in every new car and no one raises an eyebrow at that."