will go on ...

The Star Malaysia - Star2 - - HEALTH -

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.”

Cost com­par­i­son

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

Less sat­is­fied

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

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