Why is Heart Failure So Difficult to Manage?

The Problem Today

Heart Failure (HF) affects over 10% of all Medicare beneficiaries who are responsible for over one-third of all Medicare expenditures[1]. Seventy-five percent of HF patients with worsening conditions are admitted to a hospital and one-half of those are readmitted to a hospital within 6 months[2]. HF has been proven to be one of the most difficult and complicated chronic diseases to manage with a five-year mortality rate[3]. Why hasn’t a solution been developed to manage HF and further extend life expectancy? What challenges need to be addressed to develop a more effective solution?

Today's Solutions

Current solutions are manual and very resource intensive. With the growing concern about health care costs and health care staffing shortages, traditional efforts do not suffice. Most HF acute episodes require multiple emergency room visits and hospital admissions, leading to high costs. Traditional HF management models are not a very cost-effective way, in many instances, to predict acute episodes far enough in advance to change treatment and prevent the episode. Several studies[4] have demonstrated that the current efforts produce a significant number of false positives that the clinical staff must investigate. The traditional fee-for-service payment model does not create an impetus to develop solutions to lower cost. The growth of value-based payment models is changing the incentive system and is more supportive of new innovative solutions.

The most prevalent current solutions are either manual solutions or expensive and invasive implantable devices. The manual solutions include the use of weight scales, blood pressure cuffs, and pulse oximeters. The most significant clinical disadvantage of these solutions is that they rely on non-specific, lagging indicators that create a reactionary clinical decision-making process. Implantable devices involve an invasive surgical procedure, such as implanting a sensor in the pulmonary artery. Many patients do not want to have an interventional procedure due to the increased risks until their HF condition reaches an advanced stage. It has also been reported that these invasive solutions do not fully solve the issues of patient adherence.

The Solutions of Tomorrow

In summary, the issues that need to be addressed in developing an innovative solution to better manage the patient with HF, improve their care, enhance their quality of life and potentially extend their life expectancy rate include the following:

• A cost-effective solution that provides a return on investment for value-based payers.

• A Non-invasive solution, such as a wearable application.

• A solution that is easy for patients to use so that there is a high level of compliance.

• A solution that engages the patients in taking an active role in their care.

• A home-based solution that helps avoid expensive emergency room visits and hospital admissions.

• A solution that helps predict acute episodes far enough in advance that clinicians can intervene and alter treatment to prevent acute episodes.

• A solution that does not provide a high incidence of false positives.

• A solution that utilizes the latest technology, including sensors, to measure physiological data and artificial intelligence (AI) to measure trends.

• A solution that is integrated into the organization’s electronic medical records to enable easy access to clinical data and trends.

• A solution that can be integrated into the organization’s care management model and provide patient triaging, so the care managers can focus on the high-risk patients. This could result in a significant improvement in the productivity of care managers and reduce expensive staffing.

• A solution that improves quality in areas such as reduced re-admissions and improved patient satisfaction. Both will usually improve Medicare payments in value-based payment arrangements.

ADI Is Taking Healthcare to Heart

Analog Devices (ADI), a global semiconductor leader that bridges the physical and digital worlds by combining analog, digital, and software technologies into solutions that enable breakthroughs, is taking on this difficult task to address these issues in order to develop a solution to address each of these challenges by developing an effective and technology-driven solution to managing heart failure. This work is rapidly advancing and there is hope for an innovative solution to meet the challenging needs of the HF population.

[1] “The Cost Burden of Worsening Heart Failure in the Medicare Fee for Service Population: an Actuarial Analysis.” Milliman, March 2017

[2] Storrow AB, Jenkins CA, Self WH, Alexander PT, Barrett TW, Han JH, et al. The burden of acute heart failure on U.S. emergency departments. JACC Heart Fail. 2014; 2: 269-277

[3] Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol 2017;Nov 12:[Epub ahead of print].

[4] J. Voigt et. al.: A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States; Clin. Cardiol. 2014;37(5):312–321.