will go on ...
ing under healthcare reform is not going to play out the way they envisioned,” he said.
Implanting a single heart pump, which is usually covered by Medicare and private insurance, can cost US$150,000 to $200,000 (RM450,000 to RM600,000) or more. That includes the US$80,000 (RM240,000) price of the device, several weeks of hospitalisation, and other medical expenses.
If only 20,000 people opted for a pump – at even the lowest estimated cost – it would add US$3bil (RM9bil) to healthcare spending annually.
“It’s a lot of money spent in the last part of life for a patient who’s typically 75 to 80 years old,” Dewey conceded. “But can we afford not to do it? Some of these people served in World War II. They paid into Medicare all their lives. They earned this.”
Proponents of the pump maintain that its cost was comparable to the amount typically spent on medical care – about US$150,000 (RM450,000) – in the final two years of life for a heart-failure patient. The results of a clinical trial, published last December, suggested that a carefully selected group of severe heart-failure patients could benefit from having a heart pump, also called a left ventricular assist device or LVAD.
The study in The New England Journal Of Medicine reported that 58% of the participants who got the implant – including Senter – were alive after two years and had not suffered a stroke or needed a pump replacement.
By comparison, patients using an earlier version of the heart pump had a 24% survival rate after two years and avoided those serious complications.
But the study also outlined a host of other potential complications for HeartMate II users, including gastrointestinal bleeding, infections, heart arrhythmia and respiratory failure that sent patients back to the hospital.
“It’s difficult in the sense that these patients have to be dedicated to the treatment,” Dewey said. “It’s not something they go into lightly.”
Not all heart-failure patients would qualify to get a pump.
First, a close family member, such as a spouse, would have to be trained to help maintain the pump and watch out for complications after the implant.
A patient also would have to tolerate the blood-thinner Coumadin to prevent blood clots. And significant health problems – such as cancer, diabetes, or other organ failure – also would rule them out.
“The patients we’re putting these (pumps) into are in better shape than they used to be,” Meyer said.
However, elderly patients also have been known to resist the pump.
“Some patients at 75 will say they’ve done what they want to do with their lives, and they don’t want to go through another operation,” said Dr Mark Drazner, a cardiologist and medical director of UT Southwestern’s heart-failure and transplant programme. “This is for the patient whose heart is limiting them from doing anything. And there are things in their life they still want to do.”
Certainly, Sender exemplifies that group.
His pump has allowed him to spend the last two years deciphering lessons from the Bible to share with members of his church. His
Marilyn Moore, a 73-year-old resident of Octavia, Oklahoma, got a heart pump two years ago at Medical City but has had a different experience.
The cost of going to Dallas for care has used up the money she and her husband, Alvin, saved for retirement.
The pump has allowed her to perform basic chores: sweep, wash dishes and do laundry, but not work in her beloved garden.
“I wish I had more energy,” she said. “But I have to carry these batteries around with me. Sometimes it gives me a backache.”
Patients with the latest heart pump are saddled with five or six pounds of external batteries and other equipment to keep it operating during the day.
At night, the power line connects to an outlet.
No one can predict the HeartMate II’s life expectancy.
So far, it has been proved to operate for at least two years and might run as long as five or more.
”It doesn’t tend to confer immortality,” Dewey cautioned. “People still fade.” – The Dallas Morning News/McClatchy-Tribune Information Services