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Next-generation cardiac pump improves outcomes, cuts costs
In a presentation at the annual meeting of the Heart
Failure Association of the European Society of Cardiology,
investigators from Brigham and Women’s Hospital recently
presented evidence that a next-generation cardiac pump
device not only improves long-term outcomes but may also
decrease cost of care over time for heart failure patients.
The research team analysed results from the
MOMENTUM 3 trial, which compared two devices: the
HeartMate II (current generation) and HeartMate 3 (a novel,
centrifugal-flow pump), both manufactured by Abbott Inc,
which sponsored the study.
‘The HeartMate 3 left-ventricular assist device (LVAD)
is a more forgiving pump in terms of clinical adverse events,
and now we can confirm that its increased effectiveness is
associated with decreased costs,’ said Dr Mandeep Mehra,
executive director of the Centre for Advanced Heart Disease
and medical director of the Heart & Vascular Centre at
Brigham and Women’s Hospital. ‘In medicine, most often,
a therapy that demonstrates increased effectiveness usually
comes at a higher price, and we are able to show that this new
technology actually decreases costs to payers and patients
over time.’
Mehra and colleagues found that the newer device
reduced costs due to re-hospitalisation by 51%, largely driven
by a decrease in stroke and pump malfunction requiring
re-operation due to pump thrombosis. Patients who received
the HeartMate 3 experienced fewer hospitalisations and, on
average, spent 8.3 fewer days in the hospital per year than
those who received the HeartMate II. The authors note
that it may be possible to further reduce costs by decreasing
outlier complications and reducing hospital length of stay
and decrease early complications by improving patient
selection criteria and considering this therapy before patients
get too sick.
In April, Abbott Inc issued a field safety notice regarding
HeartMate 3 outflow graft twist complications with
an incidence rate of 0.72%. The US Food and Drug
Administration (FDA) issued a Class I recall but did not
recommend the return of LVADs or avoidance of use in new
patients. The current study re-reviewed 20 hospitalisations
(five in the HeartMate 3 and 15 in the HeartMate II
populations) and in a conservative analysis, classified them
as being device-related for the purposes of this analysis.
Nonetheless, the data still demonstrated a reduction in
re-hospitalisation-related hospital days and significant cost
savings for the HeartMate 3 compared to the HeartMate II.
Source:
Medical Brief 2018