Abington Memorial Hospital Offers Innovative Solutions in the Medical Management of Patients with Congestive Heart Failure

By Robert A. Watson, III, M.D.

Abington Memorial Hospital’s Comprehensive Heart Failure Program provides a full spectrum of care for individuals with heart failure. Working in close collaboration with the patient’s cardiologist, the Heart Failure team is highly skilled in treating individuals with early to late stage disease.

The Program consists of a specialized inpatient heart failure nursing unit, a subspecialty medical Heart Failure Service, outpatient Heart Failure Center and heart failure trained visiting nurses. By this team approach, the Program manages heart failure with a patient- centered approach which utilizes multiple disciplines across the continuum of care settings. Using cutting-edge diagnostic techniques such as cardiac catheterization, impedance cardiography, 3 D echocardiography and electrophysiology in specially appointed laboratories, cardiologists and advanced medical professionals determine severity of illness and appropriate solutions for optimum results.

Among the many advanced treatment options are echo optimization of cardiac resynchronization therapy (bi-ventricular pacing for coordinated and effective heart pumping) and Aquapheresis therapy. With the latter, Program specialists can monitor and remove excess fluid buildup in patients with CHF.

One of the more serious complications of congestive heart failure occurs when the patient’s body retains salt and water. This results in increased weight, swelling in the abdomen, arms and legs, and shortness of breath due to congestion in the lungs. Often the patient requires hospitalization: the organs, already under stress from decreased blood flow, must cope with the added fluidic pressure.

Using the Aquadex FlexFlow system®, the Comprehensive Heart Failure team employs Aquapheresis to siphon excess salt and water from the patient’s body. The goal is to restore euvolemia, or fluid balance. Aquapheresis represents isotonic fluid removal, extracting greater amounts of sodium, versus sodium-poor, hypotonic fluid removal with diuretics. Additionally, Aquapheresis reduces the adverse neurohormonal activation (compared with diuretic therapy which increases it) that occurs in patients with this volume overload.

Also known as “ultrafiltration,” the technique involves the removal of blood through peripheral or central venous catheters. Salt and water is filtered from the blood gradually through a console containing two pumps. The excess is collected in a special bag, while the blood is safely reintroduced to the body in less than a minute. Patients are given an anticoagulant prior to and during treatment to prevent the incidence of clotting within the blood filter. Approximately 33 cc of extracorporeal blood is extracted at any given time. Comparatively, older forms of ultrafiltration require 300-400 cc of extracorporeal blood removal.

Patients are monitored by Abington’s Heart Failure Service throughout the process. Electrolyte balance is maintained throughout the extracorporeal therapy, as an average of 100 to 500 cc of fluid can be removed per hour. This can be easily adjusted to filter more slowly if necessary. This degree of fluid removal equates with significant weight reduction over a brief period of time. This weight loss frequently is better maintained than weight loss with diuretic therapy.

Treatment duration depends on the patient’s condition, but the average length of the procedure is 24-72  hours in the inpatient setting and 8 hours in the outpatient setting.

Patients may begin to feel better immediately, or gradually experience lessening of symptoms like shortness of breath, in accordance with the severity of their conditions. The Comprehensive Heart Failure Program at Abington Memorial Hospital has been offering Aquapheresis since July 2009, effectively improving the reduction in readmission rates and improvement in overall quality of life in more than 50 patients. We are pleased to offer Aquapheresis as an advanced, beneficial alternative with minimal risk to those suffering from the complications of heart failure.

For more information or to refer a patient for Aquapheresis or other heart failure services within The Comprehensive Heart Failure Program at Abington Memorial Hospital, call 215-481-4100.

Robert A. Watson, III, M.D. is Chief, Division of Cardiology, and Co-Director, Comprehensive Heart Failure Program at Abington Memorial Hospital.