Transcript 3 Options for Uninsured/Medicaid Pending patients

Wearable Cardioverter Defibrillators:
Non-invasive, immediate, automatic therapy for
patients at risk for SCA
Welcome!
Julie Hergenrader
Territory Manager
Objectives
 Discuss how to identify patients at high risk for SCA
 Recognize the clinical circumstances that justify use of
a wearable defibrillator
 Understand the functionality and management of a
wearable defibrillator
 Review important patient instructions
Sudden Cardiac Death
 How many people die of SCD every year?
Societal Impact of SCA
 Annual Number of Deaths from Selected Causes in
the United States





AIDS
Breast Cancer
Lung Cancer
Stroke
SCA
16,605
40,480
160,390
133,750
450,000
 SCA accounts for more deaths each year than these
other diseases combined!





(1) CDC statistics HIV/AIDS 2008
(2) American Cancer Society, Inc., Facts and Figures 2008.
(3) 2007 American Lung Association statistics
(4) CDC statistics Stroke 2008
(5) JACC, Sept 18, 2007. Buxton et al.
Playing The Odds?
Where would you choose to have your cardiac
arrest?
A.
B.
C.
D.
E.
F.
New York City or Chicago
Seattle
Hospital
American Airlines Flight
Las Vegas Casino
None of the above
Playing The Odds?
Where would you choose to have your cardiac
arrest?
Overall: 5% (no change in 20 years!)
A. New York City or Chicago: 1%
B. Seattle: 30%
C. Hospital: 17 % survival to D/C
D. American Airlines Flight: 40%
E. Las Vegas Casino: 70%
F. None of the above
Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from
the National Registry of Cardiopulmonary Resuscitation 2003
Out of Hospital Cardiac Arrest
Factors determining survival after out of
hospital cardiac arrest
• Time between collapse and start of resuscitation
• Time to defibrillation
• Availability of AED’s in public
Questions
 What is the #1 predictor of SCD?
Answer
 LOW EJECTION FRACTION ≤ 35%
Who is at risk?
Heart Failure/NICM/DCM
 Approximately five million
people affected
 550,000 new cases each year
 Fifty percent overall mortality
at five years
 Fifty percent of mortality is
due to SCA
Post MI
 The risk of sudden cardiac
arrest post-MI is the highest in
the first 30 days
 Post-MI patients with heart
failure are at 4-6 times greater
risk of sudden cardiac arrest in
the first 30 days after MI
 Most (83%) of first month
SCA occurred after hospital
D/C
Who is at risk?-Heart Failure
Scope of the problem
 Approximately five million people affected
 550,000 new cases each year
 Heart failure affects one in 10 patients over age 70
 Number one DRG
 High costs
 Fifty percent overall mortality at five years
 Fifty percent of mortality is due to SCA
American Heart Association (2001) Heart and Stroke Statistical Update
Who is at risk?-Heart Failure
 Ischemic Cardiomyopathy (ICM) and or Non-ischemic
cardiomyopathy (NICM) contribute to development
of Heart Failure







Past myocardial infarction
Coronary artery disease
Infectious (viral)
Familial
Drug induced (alcohol, cocaine)
Peri & Post-partum
Tachycardia induced (hyperthyroid, A. Fib)
Cardiomyopathy is associated with increased risk of sudden
cardiac arrest.
Who is at risk?-Post-PCI
 1 in 5 (~20%) AMI post-PCI patients are at high risk of dying
within the first year
 Most mortality occurred in the first 3 months
 30 day and 1 year mortality can be predicted based on 7
variables at time of PCI1
 Those with a CADILLAC Risk Score > 6 are at highest risk
 Baseline LVEF is the most powerful predictor of mortality.
What is the LifeVest?
 The LifeVest
System is
indicated for
Adult/Pediatric
patients who are
at risk for sudden
cardiac arrest and
are not candidates
for or who refuse
an implantable
defibrillator.
Benefits of a WCD
 Allows patient to be discharged from a monitored bed to home environment
and remain protected from SCA
 Improves QOL for patient and family
 Freedom to do whatever activities patient is permitted
 Freedom for family members to leave the patient for short periods
 Patients feel protected and safer with WCD
• The WCD represents an alternative approach to prevent SCA until ICD
implantation is clearly indicated or the arrhythmic risk becomes lower or
absent. WCD is not an alternative to ICD, but may be used until patients
are selected for and/or become eligible for ICD
• The WCD is effective in providing immediate lifesaving defibrillation for
patients at high risk for VT/VF and has been proven useful in those patients
whose SCA risk is changing or uncertain
The WCD System
ECG Electrodes
• Dry & nonadhesive
• 4 electrodes
providing 2
channels of
monitoring
Self-Gelling
Defibrillation
Electrodes
Response
Buttons
Monitor
• 150 joules
biphasic
• Stores ECG,
daily use, etc.
Dry, comfortable electrodes
ECG
electrode
Defibrillation
electrode
Gel capsules
LifeVest Features
Self gelling defibrillation electrodes
No gel, no adhesive ECG electrodes
Lightweight (1.8 lb monitor)
Consciousness test before shock
150-joule biphasic shock
Captures ECG 30 seconds before event
Stores up to 75 minutes of ECG
Alarm Sequence
1.
2.
3.
4.
5.
6.
7.
Arrhythmia detected, activating vibration alert (continues throughout sequence).
Siren alerts begin (continues throughout sequence).
Siren alerts get louder.
Patient audible prompt: “Electrical shock possible.”
Gel release.
Bystander audible prompt: "Do not touch patient.”
Treatment shock.
Response Buttons
 Overall incidence of
inappropriate shocks is low at
1.4% per patient month of wear
Chung et al, JACC. 56;194-203, 2010
Siren Alarm
Ventricular Tachycardia
Ventricular Fibrillation
Artifact
Gong Alarm
Flipped electrodes
Therapy pads adjustments
Loss of signal
Data Transmission
Data Points
 Constant monitoring and protection of SCD with
superb results: 98% first shock conversion
 92% of Patients arrive at ER conscious and alert
 Designed for transitional SCD risk periods (the
coverage “gaps” in ICD policy)
 Allows protection from a life-threatening arrhythmia
and time to determine long term course of treatment
as well as ensuring patient returns for follow-up visit
Medical Order Form
Supporting Documentation
QUESTIONS…