Abstract 16203: A Case for Cardiomems Use in Cardiac Amyloidosis to Prevent Hospitalization

Background: Patients with cardiac amyloidosis (CA) have recurrent hospital admissions for heart failure (CHF). However, CardioMEMS placement is still considered ‘investigational’ by various insurance payers, requiring peer-to-peer review for approval. Landmark CardioMEMS trials did not identify CA patients in their cohort, so the benefit is unclear. Results and Discussion: Three patients with symptomatic CA (2 with light-chain, one with transthyretin CA) are presented. All the patients had chronic kidney disease stage 3, worsening orthostatic symptoms with heart failure medical therapy and a history of ≥ 2 hospitalizations/year for CHF with acute kidney injury. To prevent further hospitalizations, CardioMEMS was planned but denied by their respective insurance companies as ‘investigational use’, which required a rigorous appeal process to overturn. One year prior to CardioMEMS, there were 8 hospitalizations due to CHF between all three candidates. After implantation, there was only 1 CHF-related hospitalization. This represents a 88% decrease in hospital admissions for CHF, saving a potential 7 CHF hospitalizations in the succeeding year and potentially adding one quality-adjusted life-year (QALY)/patient. Decompensated CHF adversely affects the quality of life of CA patients. CardioMEMs costs $20,000/device on average and $100/month of monitoring cost. The average cost of heart failure hospitalization is $14,000. Amongst the 3 patients, there was a total expenditure of $112,000 in hospitalizations prior to CardioMEMS placement. With an 88% reduction in hospitalization and correcting for the cost of device placement and monitoring, there was a $11,653/patient/year decrease in spending with CardioMEMS placement. Additionally, the cost of adding 1 QALY/patient was only $21,200 with CardioMEMS. The Institute for Clinical and Economic Review values one QALY at $50,000 to $150,000 as an acceptable cost and the expenditure with CardioMEMS comes significantly lower.

Conclusion: CardioMEMs has been shown to decrease the number of hospitalizations in patients with HF and has a similar benefit in patients with CA. The CardioMEMs device has the capability to improve patient quality of life and decrease the cost of medical care of CA patients.