For Health Professionals: End-Stage Heart Failure (Destination Therapy)
For additional information about Destination Therapy treatment at UW Hospital and Clinics, contact:
Maryl Johnson, MD, Director, Heart Failure/Transplantation
UW Hospital and Clinics is among the first in the nation to meet the Centers for Medicare and Medicaid Services (CMS) coverage and performance criteria for permanent implantation, or "Destination Therapy," of left ventricular assist devices.
Having received Medicare approval to perform Destination Therapy, the UW Health Heart and Vascular Care program would like to make sure physicians are aware of this treatment option and patient selection criteria. As a referring physician for Destination Therapy, you will collaborate with UW Hospital and Clinics to optimize outcomes for your heart failure patients. Your patients will be referred back to you for follow-up and long-term management.
A New Option: HeartMate® XVE LVAS
Mechanical circulatory assist devices and advances in interventional treatments are expanding the range of options for treating heart failure patients. Since the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial with the HeartMate® VE Left Ventricular Assist System
(LVAS) for Destination Therapy, advances at a clinical and device level have continued. Over and above medical management, physicians now have new options for improved quality and length of life for heart failure patients who are not candidates for cardiac transplantation.
The newest generation of heart assist devices, the HeartMate® XVE LVAS is the first and only left ventricular assist device approved by the Food and Drug Administration for Destination Therapy. The REMATCH study demonstrated that most recipients of HeartMate® Destination Therapy can improve two classes of NYHA function. In fact, four times as many HeartMate® Destination Therapy surviving patients were class I or II versus those receiving optimal medical management.
In addition, the Centers for Medicare and Medicaid Services has approved Destination Therapy for Medicare reimbursement effective October 2003. With the advances in technology, successful outcomes and the removal of some financial barriers, HeartMate® Destination Therapy can benefit many people in the hands of capable clinicians.
The following are referral indications for heart failure patients who may be candidates for HeartMate® Destination Therapy:
- Inability to maintain hemodynamic stability (eg. intolerance to drug therapy)
- End-organ dysfunction (eg. renal or hepatic)
- Diminishing quality of life (eg. Class IV heart failure symptoms)
- Increasing frequency of hospitalizations for exacerbation of heart failure symptoms
Recent advances in mechanical circulatory assist devices and interventional treatments have expanded our ability to treat heart failure. In 2004, UW Hospital and Clinics began providing physicians in our community with an expanded range of educational opportunities focused on mechanical circulatory assist devices and other advances in the continuum of heart failure treatment, including HeartMate® Destination Therapy.
Through collaboration with physicians in our community, our goal is to provide hope where hope has not previously existed for heart failure patients and their families. Physicians referring their heart failure patients to a Heart Hope®
Center become part of a team focused on optimizing outcomes.
What’s more, heart failure patients can return to their physician post discharge in better condition than when they were referred. We encourage you to join us in this goal by providing your heart failure patients with a new beginning.