How Specialists Are Addressing Heart Failure

Mark E. Dunlap, MD, tells MD Magazine about team-based approach and advancing technology's role in cardiovascular care.

Mark E. Dunlap, MD, director of the Heart Failure Section at the Heart and Vascular Center of The MetroHealth System in Cleveland, OH: One of the ways that we and many other places have tried to get the biggest bang for the heart failure buck is try to expand from the traditional one on one patient doctor relationship. There’s no way we can deliver care to close to 6 million people with that model. So we are using a variety of alternate ways than this one on one doctor patient encounter. We are making a lot of use over our expanded providers.

In addition to that, we increasingly use telephone visits. It becomes a little challenging on the reimbursement side, but compared with a patient being admitted to the hospital or coming to the emergency department with decompensated heart failure, it is a very helpful adjunct. We do some telemedicine consults with some devices that are little supped up from Skype. But the physical exam for the assessment of the heart failure patient, one of the really most important components of that physical exam from a heart failure standpoint, is to look at their jugular venous pressure. I wouldn’t bet my career on measuring that jugular venous pressure on a patient with telemedicine, so hopefully our technology continues to improve.

The other type of telemedicine is with the use of implantable monitors. Some of them are available as an accessory to a pacemaker or a defibrillator, but we now also have a device that is planted in the pulmonarty artery which gives us information with regards to the pulmonary artery systolic and diastolic pressure. It really can help manage very complicated patients. It’s a relatively expensive proposition, but ifi t can prevent some hospilatizations, it makes a lot of sense.