How Lifesaving Therapies Are Reaching More Heart Patients

Breakthrough technology allows doctors to monitor your every heartbeat — from thousands of miles away

Sari Harrar,

AARP

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Published September 27, 2024

digital illustration of a heart rate monitor

Ollie Hirst

Larry Goodman checks his weight, blood pressure and pulse every morning. Then, as he makes breakfast in his kitchen in Middletown, Delaware, a digital health company 3,000 miles away in California reviews his numbers.

“When you have a bad heart, every time you feel something you think, This is it,” says Goodman, 69. “But I don’t panic anymore. If there are numbers I don’t like, I get a call from my doctor’s office in 10 to 15 minutes.”

Like half of the 6.7 million Americans with heart failure, Goodman has a type called heart failure with reduced ejection fraction, meaning that the left side of his heart is too weak to pump enough blood out to his body.

Goodman first landed in the hospital with heart failure 15 years ago, unable to breathe and with fluid accumulating in his body, and for many years was in and out of the hospital.

Recognize early heart failure signs

Nearly 1 million U.S. adults are diagnosed each year with heart failure, but more than one-third of cases are missed by primary care physicians at early, more treatable stages, according to a 2021 study.

Don’t overlook the early warnings of heart failure:

Shortness of breath
A dry cough that’s worse at night
Tiredness
Nausea
Low appetite

Leg swelling and an increase in the girth of your torso are potential indicators of fluid buildup when the heart isn’t pumping strongly, says Sourin Banerji, M.D. If you are diagnosed, make an appointment with a heart failure specialist, Banerji suggests.

A few years ago, he joined a program at ChristianaCare, a Delaware-based health system that offered a new digital monitoring program aimed at helping Black Americans with advanced heart failure get access to a breakthrough treatment: a combination of four drugs that together can save lives.

The drugs cut the risk of early death by 70 percent, improve symptoms and even help the heart function better. Without them, 10 to 15 percent of people with advanced heart failure are likely to die in just two years. In 2022, the American Heart Association and American College of Cardiology updated their guideline-directed medical therapy and for the first time recommended these four drugs, hailed as the “fantastic four.”

Yet most people who could benefit aren’t getting them. In a 2024 Duke University study of 33,036 older adults hospitalized for heart failure, 4 out of 5 were candidates for the drug combo but fewer than 1 in 6 got them. Among older adults, rates are especially low.

A big reason: It's not a one-size-fits-all therapy. Check-ins and follow-up are required to make sure each patient is getting the right dose of the medications for their unique needs, and that they’re able to tolerate any side effects.

But a tidal wave of new digital and remote monitoring programs is helping to change the trends. Instead of making frequent trips to the doctor or worrying about the drugs’ effects, those with heart failure can now track key health indicators at home with close monitoring by health care practitioners.

“It’s almost like the clinic is brought to the patients,” says Sourin Banerji, M.D., medical director of advanced heart failure at ChristianaCare Health. Other health systems are using a variety of home monitoring options, including an implanted sensor called CardioMEMS, approved by the U.S. Food and Drug Administration in 2022.

It’s helping. A study of 151 ChristianaCare patients who were monitored found that the number of heart failure patients taking all four medications increased from 11 percent to 68 percent in 90 days.

“We see every day how much better our patients are doing,” Banerji says. “They have more stamina. They can remain independent longer. They’re less likely to be readmitted to the hospital.”

The four types of drugs used in this treatment strategy are a combination of mineralocorticoid receptor antagonists to remove extra water and sodium from the body; blood pressure drugs that help to relax blood vessels so the heart doesn’t have to work as hard; beta-blockers to reduce heart rate and sometimes repair some heart damage; and sodium glucose cotransporter-2 inhibitors, diabetes drugs shown to reduce symptoms and deaths in people with heart failure.

Goodman is on all four medications now, with two at optimal levels and two others still being adjusted. Like many older adults with heart failure, he and his doctor are balancing medications and the ups and downs of several health conditions. “My doctor adjusted my doses often,” he says. “And I do feel better. Less breathless.” A lifelong trumpet player, Goodman hopes his stronger, steadier heart will let him get back to participating in Taps Across America, a nationwide Memorial Day observance.

Other innovations in heart health

Artificial intelligence to lower blood pressure: About 68 percent of Americans with high blood pressure have their pressure well controlled. MedsEngine uses AI to analyze and improve treatments. It increased the number of patients with well-controlled hypertension to 93 percent in one Dayton, Ohio, medical practice.

Supermarket carts spot A-fib: In a recent U.K. study, grocery store carts fitted with electrocardiogram sensors in the handles uncovered 39 cases of previously undiagnosed atrial fibrillation (A-fib), irregular heart rhythms that can raise the risk for stroke.

A test and treatment for blood lipids: High levels of the blood fat Lp(a) can boost risk for heart disease six times higher than the more well-known low-density lipoprotein (LDL). Five experimental Lp(a)-lowering drugs are in development, including zerlasiran, a gene-silencing treatment that lowered levels 90 percent in a human trial.

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