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.
Implants for Everyone? continued...
Rose agrees, and argues that the high costs depend on the comparisons we use. "If you compare implanting an LVAD with administering a measles vaccine, an LVAD is going to be a lot less cost effective," he says. "But there are other procedures that have become accepted, like radiosurgery for brain tumors, that are even costlier."
Still, the costs are a serious impediment right now, and a great deal depends on what kind of coverage insurance companies provide. As more and more devices are developed, experts are working to devise better ways of figuring out who will benefit from them the most.
The Future of Device Treatment
Bristow says CRT is just the first wave of new devices designed for different aspects of heart-failure treatment.
"They're working on anything you can imagine," he says. He mentions devices that will physically restrain the heart from enlarging -- a process that leads to worsening heart failure -- and others that will correct leaking heart valves.
Devices like LVADs may offer a glimpse into heart-failure treatment for end-stage disease in the future. While stories about fully artificial hearts tend to grab headlines, such devices have limited use at this point. "The problem with the total artificial heart is that, as elegant as they have become, they still have to be absolutely flawless," says Rose.
LVADs, which use technology to supplement the heart's natural function, may be a more realistic approach in the near future. ""It's the best way to improve the quality of life for these people," Watson tells WebMD. "Although we talk about it a lot, our chances of making a bionic person are still pretty remote."
Although devices are sometimes compared unfavorably with drugs because of their costs, many experts consider it a misleading comparison. Instead, devices and drugs will be developed to work together for heart-failure treatment. For instance, Bristow became involved in CRT not because of an inherent interest in mechanical devices, but because he thought that CRT had the potential to improve heart-failure treatment with medications called beta-blockers.
Watson agrees and believes that heart-failure treatment with both drugs and devices will be important. "So far though, I don't think that there's been enough of a concerted effort to study the combination of drugs with devices," he says. "Most trials tend to look at one or the other."
Devices may prove to be useful tools for implementing promising new heart-failure treatments, such as cell implantation or gene therapy. "What we do now is called passive bridge to recovery, where we put in the LVAD and hope that whatever is wrong with the heart naturally works itself out," says Rose. "I think what we'll see in the future is active bridge to recovery where, in addition to putting the device in, we'll administer cells, or genes, or new or even old drugs to help repair the heart. Once the therapy works, the device could be removed."