Remission from End Stage Heart Failure: Thoughts on VADs from Penn's J. Eduardo Rame, MD

The prevalence of heart failure (HF) in the United States is expected to increase by 46% between 2012 and 2030.  

Dr. J. Eduardo Rame of Penn Medicine

Recovery from heart failure, the condition in which the heart is incapable of pumping blood at a life-sustaining rate, is an unmet need, explained J. Eduardo Rame, MD, Medical Director, Ventricular Assist Device Program at Penn Medicine, in a recent interview with ReachMD

Treating Advanced Heart Failure 

“Researchers are still working on the cause of heart failure and its progression,” Dr. Rame explained, noting that the heart often adapts following insult and that patients may do well thereafter for a time. “But then somehow — despite some advances in device therapy — there’s still disease progression.”

An increasing number of patients with heart failure are surviving through the use of left ventricular assist devices (LVADs). The Interagency Registry for Mechanically Assisted Circulatory Support, or INTERMACS, now has more than 20,000 people enrolled. The vast majority have continuous flow devices, like the HeartWare and the HeartMate II, both available at Penn Medicine. 

Improving LVAD Mortality Rates

Despite the enormous technical advances in recent years, LVAD patient survival hasn’t increased beyond 80% at year one, or 70% at year two. The primary culprits include infection, stroke and continued inotrope requirements, according to the eighth INTERMACS registry

“Failure on the right [side] is, for whatever reason, not completely understood,” Dr. Rame shared.

Despite these data, Dr. Rame believes that LVADs hold an important place in the future of heart failure therapy: A Penn heart failure researcher and clinician, he and his colleagues at Penn Medicine have investigated LVAD risk factors — as well as ways to improve outcomes for the devices.

LVAD Research at Penn Medicine

  • Optimizing Survival Dr. Rame and his Penn colleagues are approaching a number of heart failure challenges from various perspectives. In the last year or so, researchers at the University of Pennsylvania, Columbia University, and other leading academic medical centers, for example, have devised a pre-LVAD implantation model to determine a patient’s optimum chances for survival with current types of continuous flow LVAD support. The model is based on clinical and echocardiographic measurements.
  • Bridge to Recovery Another key study taking place at Penn Medicine and elsewhere, Remission From Stage D Heart Failure (RESTAGE-HF), is investigating promising evidence that in carefully selected patients, continuous flow LVADS in combination with medication can induce reverse remodeling of hearts damaged by heart failure. Speaking of the study in a recent interview, Dr Rame said, “The hearts return to an earlier stage of heart failure from NYHA Stage IV. In other words, what we’re seeing is remission from heart failure.”
  • Improving Safety Penn Heart and Vascular was also a participant in the landmark ENDURANCE trial, a study that compared the safety and efficacy of the HeartMate III to that of the HeartWare HVAD. In the ENDURANCE trial, Dr. Rame said, researchers saw improvement both in survival and in adverse events, noting that he and his colleagues at Penn continue to work to “decrease the adverse events even more, decrease the rate of stroke, if possible understand why people have gastrointestinal bleeding… and finally maintain or decrease the rate of infection, as well.”

Referring Patients to a Heart Failure Specialist 

In his ReachMD interview, Dr. Rame shared some practical, salient advice to fellow cardiologists and primary care physicians on when to refer patients with end-stage disease to the heart failure program at Penn Medicine – the sooner the better. If the patient is still failing despite the best efforts of the primary care physician, the primary cardiologist, the experienced team of electrophysiologists or interventionalists who know the patient, it’s time to consider advanced end-stage therapy at Penn Medicine.

If you think your patient is a candidate for an LVAD, consult with the Penn Medicine Heart Failure clinical team: Call Penn’s 24/7 provider-only line at 877-937-7366.

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The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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