Treatment Options

Pacemaker for the Treatment of Heart Failure

Moderate Value

The heart is a hollow muscle that consists of four chambers, called the atria (the top two chambers) and the ventricles (the bottom two chambers). The heart contracts and relaxes in response to a unique electrical system within the heart muscle. In a healthy heart, the four chambers work together contracting and relaxing in a coordinated, organized manner. This motion pumps blood through the body, supplying the organs and tissues with oxygen and nutrients.

In heart failure, the heart is weakened and fails to pump enough blood to meet the body's needs. Heart failure usually occurs from weakening of the heart over a long period of time. The heart responds to the problem by trying to work harder. This puts an additional strain on the heart and leads to further damage, and the heart wears out over time. Symptoms of heart failure include shortness of breath, swelling of the feet and legs, weight gain due to fluid build-up, fatigue, and decreased physical endurance. There are many conditions that can lead to heart failure.

One way to treat heart failure is to place a pacemaker in the chest to assist the heart with its electrical activity. A problem with the electrical function of the heart is a common problem for people with heart failure.  A traditional or older pacemaker is designed to control the heart rate. The new heart failure pacemakers have a different function and goal, called heart resynchronization.

Heart resynchronization therapy involves the use of a special pacemaker that stimulates or paces both of the heart's ventricles. Roughly three to four out of every ten people with heart failure have an electrical disturbance in the conduction of electrical impulses to the lower chambers (i.e., ventricles) of the heart.

The goal of resynchronization therapy is to restore the normal coordinated pumping action to the heart by correcting the electrical problems related to heart failure. There are two types of heart failure pacemaker devices. One type sends the electrical impulses only, and these impulses adjust and coordinate the pumping function of the heart. This is the standard resynchronization device. For other people with heart failure who are at high risk of dying suddenly from heart rates that are too fast, a second device is available. It combines the electrical impulse control of the first device with a defibrillator, which shocks the heart out of deadly fast rhythms.

The heart failure pacemakers are for people that experience the following: moderate to severe heart failure, continued heart failure symptoms despite medications, an electrical delay in the lower heart chambers, and a weak enlarged heart muscle. The heart failure pacemaker consists of three parts: The generator used to create the electric impulses, the lead wires that carry the impulses, and the electrodes connecting the lead wires to the heart. Like a traditional pacemaker, the heart failure pacemaker is usually implanted beneath the skin, under the left collarbone.

Things to Consider

  • More than 5 million people in the United States have heart failure.
  • Approximately $5 out of every $100 in the United States is spent on health care costs related to the treatment of heart failure.
  • About two-thirds of this cost is for hospital treatment.
  • Heart failure causes or contributes to around 300,000 deaths each year.
  • The heart failure pacemaker received Federal Drug Administration (FDA) approval in 2001.

Results

Moderate Value

Will I live longer if I have this procedure?

The initial studies of this treatment suggest a survival benefit associated with the heart failure pacemaker when compared to traditional medical therapy. However, further study is needed to evaluate this benefit.

Will the heart failure pacemaker improve my quality of life?

Yes, studies have consistently shown improvement in exercise ability, heart failure symptoms and quality of life. Some people notice an immediate improvement and others notice a change after a few weeks or months.

Will the treatment of heart failure with a heart failure pacemaker make my symptoms better?

Yes, for the majority of people. A small number of people with heart failure do not have any improvement from the treatment.

Safety

Moderate Value

Regular checkups with your physician are necessary after a heart failure pacemaker has been implanted in your chest. It is important to always carry your heart failure pacemaker device card with you.

Minor reported complications:

  • Swelling
  • Infection

Major reported complications:

  • Infection – may require removal of the device
  • Air or blood in the lungs
  • Bleeding
  • Puncture in the wall of the heart from the pacemaker
  • Death

Comparison

Significant Value

It is important to remember these devices are used in people with advanced heart failure who continue to have symptoms even after the appropriate use of drug therapy. Heart failure pacemakers are not a cure for heart failure. They are used in addition to medications. Medications have been the primary treatment for heart failure until the heart failure pacemakers received Federal Drug Administration (FDA) approval in 2001. There is no one right medication for all people with heart failure. Most people take a combination of medications. The medications used for heart failure help rid the body of extra fluid, strengthen the heart's contraction, and ease the heart's workload by relaxing the blood vessels. Lifestyle changes are often encouraged – these changes include regular exercise and diet restrictions to reduce salt and fluid intake.

Major studies have shown several benefits with the heart failure pacemaker that include: improved exercise ability, improved quality of life (e.g., less shortness of breath), fewer or less severe heart failure symptoms, fewer hospital admissions, and a decreased rate of death.

The therapy of last resort for heart failure is a heart transplant. Transplantation is an option for only a small number of people with heart failure. There are only a small percentage of people recommended for heart transplant surgery that actually get a transplant. This is due to the limited number of hearts available for transplanting and the health condition requirements of the candidate. Unfortunately, there are many more people on the waiting list than there are hearts available each year. Waiting time may extend several years.

Cost

Moderate Value

The heart failure pacemakers range in cost from $35,000 to over $45,000. The additional cost of the procedure with associated medical care varies greatly depending on the place that the person receives the pacemaker. In an outpatient setting, where the procedure is done on the same day of discharge or the day prior to discharge, the average cost is over $2,000 plus the cost of the pacemaker. However, in the inpatient setting, where you are admitted to the hospital, the average cost is over $60,000 plus the cost of the pacemaker.

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

CHF Patients.com. (2007, January). Pacemakers. Retrieved January 9, 2014 from http://www.chfpatients.com/implants/pacemakers.htm.

MayoClinic.com. (2013, April). Pacemaker. Retrieved January 9, 2014 from http://www.mayoclinic.com/health/pacemaker/MY00276.

WebMD. (2011, June). Pacemaker for bradycardia. Retrieved January 9, 2014 from
http://www.webmd.com/heart-disease/pacemaker-for-bradycardia.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  moderate value

safety:  moderate value

comparison:  significant value

cost: moderate value


total: moderate value

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Page modified:January 31, 2014