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The expanding role of implantable devices to monitor heart failure and pulmonary hypertension

Nature Reviews Cardiology volume 15, pages 770–779 (2018)Cite this article

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Abstract

The epidemics of heart failure and, to a lesser extent, of pulmonary arterial hypertension continue unabated worldwide and are extremely costly in terms of loss of life and earnings, as well as the burden of health-care expenditure due to repeated hospitalization. The effectiveness of newly discovered therapies for the two conditions depends on their timely application. To date, symptoms have been used to guide the application and timing of therapy. Compelling evidence now exists that symptoms are preceded by several metabolic and haemodynamic changes, particularly a rise in intravascular pressures during exercise. These observations have stimulated the development of several implantable devices for the detection of impending unstable heart failure or pulmonary arterial hypertension, necessitating admission to hospital. In this Review, we summarize the rationale for monitoring patients with heart failure or pulmonary arterial hypertension, the transition from noninvasive to implantable devices and the current and anticipated clinical uses of these devices.

Key points

  • Long-term frequent or continuous haemodynamic monitoring is now feasible.

  • Measurements of pulmonary arterial pressure from a permanent implanted device have proven efficacy in reducing rehospitalization rates for patients with chronic heart failure.

  • Hypothetically, the integration of biomarker data, clinical signs and haemodynamic data will lead to improved care of patients with chronic cardiovascular conditions.

  • The emerging issue is the cost–benefit ratio for a variety of conditions and for different stages in progressive chronic diseases.

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Fig. 1: Progression and pathophysiology of heart failure.
Fig. 2: Pathophysiology and therapeutic targets for pulmonary arterial hypertension.
Fig. 3: Estimating lung congestion using transthoracic impedance.
Fig. 4: The left atrial pressure (LAP) monitoring system.
Fig. 5: The CardioMEMs device.
Fig. 6: The Titan sensor.
Fig. 7: The surface acoustic wave (SAW) system.

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Acknowledgements

The authors acknowledge the Wellcome Trust and the UK Department of Health for their support during the development of the SAW sensor system.

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  1. National Heart and Lung Institute, Heart Science Centre, Harefield Hospital, London, UK

    Magdi H. Yacoub

  2. Institute of Biomedical Engineering, Imperial College London, London, UK

    Christopher McLeod

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Both authors researched data for the article, discussed its contents, wrote the manuscript and reviewed and edited it before submission.

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Correspondence to Magdi H. Yacoub.

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The authors are co-founders of Cardian Limited, a recent spinout from Imperial College London, UK, for the further development of the SAW sensor system.

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Yacoub, M.H., McLeod, C. The expanding role of implantable devices to monitor heart failure and pulmonary hypertension. Nat Rev Cardiol 15, 770–779 (2018). https://doi.org/10.1038/s41569-018-0103-z

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