One SGLT2 inhibitor, dapagliflozin, has been approved by the Food and Drug Administration (FDA) for patients with a weak heart, a common cause of heart failure. A weak heart can be caused by a heart attack, heart valve disease or a viral infection. Another common cause of heart failure is a stiff heart — the result of the organ’s contracting normally but not relaxing properly, causing fluid to back up into the lungs. The FDA may soon approve other SGLT2 inhibitors for heart failure patients with weak and stiff hearts, Bhatt says.
Insurance typically covers SGLT2 inhibitors for diabetes patients. For heart failure patients without diabetes, coverage depends on the carrier.
Remote monitoring can decrease hospital stays
Heart failure patients who are hospitalized frequently or live in remote locations may benefit from advances in remote-monitoring technology. A sensor implanted in the pulmonary artery — the blood vessel that moves blood from the heart to the lungs — monitors pulmonary artery pressure and heart rate. If the pressure is too high, the sensor notifies the patient’s hospital. “For the right patients, remote monitoring can decrease the need for frequent hospitalizations,” Bhatt says.
This sensor will likely be the first of many heart failure monitors that measure pulmonary artery pressure and heart rate from afar, according to Bhatt. Remote monitoring is widely available at academic medical centers and large community hospitals that treat heart failure and is covered by some insurance companies.
Adding years with a left ventricular assist device
A left ventricular assist device (LVAD), a miniature pump that performs this function of the heart, may extend the lives of those with advanced heart failure. A multidisciplinary team of heart failure specialists meets to determine whether the patient could benefit from an LVAD or a heart transplant. If the team determines that an LVAD is appropriate, the device is implanted through open-heart surgery. The device can be left in place permanently, but if heart function recovers, it can be removed. In some cases an LVAD is implanted when a patient is waiting for a heart transplant. An LVAD is typically covered by insurance.
Unfortunately, this device can lead to serious complications, such as an increased risk of stroke, Bhatt says. In the near future, advances in LVADs are expected to decrease this risk. Also, in a few years there will likely be more minimally invasive implants.