By Eman Hamad, MD
This past September, Temple physicians successfully implanted the HeartMate II LVAD in a patient with severe dilated cardiomyopathy and a BMI of 68—the second-highest BMI of any patient in the U.S. to receive the device. While it is too early to declare long-term success, the patient is moving about more freely and receiving the support from a multidisciplinary team that may help him reduce his weight and improve his cardiac function and quality of life.
Obese heart failure patients are often ineligible for heart transplants. They usually have difficulty following a diet and often can’t exercise or undergo gastric bypass surgery given their poor cardiac function.
Although implanting a ventricular assist device in such a patient is a high-risk procedure, mechanical circulatory support may allow an obese patient to lose weight, become a candidate for gastric bypass surgery and, eventually, become eligible for a heart transplant. Some patients may even recover without a transplant, since metabolic demand and stress on the heart decrease.
In clinical studies, obese heart failure patients demonstrated a better prognosis than lean or underweight heart failure patients.1 However, we do not yet know whether this holds true for the severely obese patient receiving MCS therapy, as most trials excluded patients with BMI > 40. Because such patients must follow strict dietary and exercise guidelines and receive optimal care, a multidisciplinary team that includes physicians, nurses, dieticians, exercise physiologists and psychotherapists may offer the best chance at good outcomes.
1Khalid, U., Ather, S., Bavishi, C., et al. (2014). Pre-Morbid Body Mass Index and Mortality After Incident Heart Failure: The ARIC Study. J Am Coll Cardiol. 64 (25): 2743–2749.
By Linda Ruppert, NP
Nearly 6 million Americans live with a diagnosis of heart failure. Causing 1 million hospital admissions in the United States annually, heart failure costs over $32 billion a year to treat and places a huge financial burden on our health care system.
Temple Health’s Grand-Aides Program works to address these problems by helping people with heart failure gain a better quality of life, receive excellent patient care and spend less time in the hospital. Nursing assistants visit patients in their homes to obtain vital signs and ask about symptoms such as shortness of breath, weight gain and edema, as well as issues such as dietary adherence. A supervising nurse can then follow up and adjust medications during a FaceTime® encounter. Thus, the combination of in-person attention with use of emerging technologies results in more comprehensive and cost-effective patient oversight.