Health economic effects of right heart monitoring for LVAD and PAH patients

Whitepaper 02
emka medical GmbH
Revision 01, May 2025

Abstract:      Patients with left ventricular assist devices (LVADs) and patients with pulmonary arterial hypertension (PAH) represent a high-cost segment of inpatient care, with treatment costs often exceeding 100,000 US$ per patient. These high costs are compounded by significant 30-day re-admission rates to hospital, which remain around 30% for both groups [1-3]. Each re-admission typically incurs additional costs of 40,000 to 50,000 US$, further increasing the financial burden on healthcare systems [4,5].

A primary factor leading to re-admissions in these patient groups is right heart overload, which often results in reduced right ventricular ejection fraction (RVEF). Conventional pressure monitoring, while informative, is not sufficient to fully capture these dynamics as it does not provide a continuous, beat-by-beat assessment of RVEF. This gap in real-time functional monitoring limits clinical decision making and timely intervention. There is peer-reviewed literature supporting this view, including studies authored by researchers affiliated with emka MEDICAL [6].

Before CorLog is used routinely, the health economic benefit must be proven, as CorLog monitoring incurs costs in the four-digit range. Therefore, the clinical added value must be demonstrable.

The current standard method for hemodynamic assessment when a LVAD is planned or therapy for PAH is initiated is Swan-Ganz catheterization. Swan-Ganz catheters have been used to measure the pressure in the right heart since the 1970s. These catheters are inserted through central veins and pass through the tricuspid valve. The ESCAPE study, which involved 433 patients monitored with Swan-Ganz catheters, showed that tricuspid regurgitation can develop after only a few days [7]. This is not surprising as Swan-Ganz catheters are usually have French size of F5 or F7, with F7 having twice the cross-sectional area of F5, causing significant mechanical stress on the tricuspid valve. In addition, the risk of infection increases with longer dwell times, which is why the instructions for use clearly warn against use beyond several days [7].

Modern Swan-Ganz catheters, such as the IQ version, are also capable of measuring right ventricular pressure profiles. Although these signals lack high-frequency fidelity due to hydrodynamic attenuation in the fluid-filled pressure lines and the use of externally attached pressure transducers, the data they provide can still be processed using the CorLog algorithm. This enables the estimation and trending of RVEF. Patients who have an unstable RVEF are precisely those who benefit most from continuous 24/7 CorLog monitoring. This also applies to times when patients are mobilized – a physiologically beneficial activity, but one that leads to dynamic circulatory changes. In such situations, real-time monitoring of right heart function provides important information for timely clinical decision making.

The Echo control of CorLog pressure based ejection fraction (PBEF) shows a very good Echo measured compliance at a PAH patient treated with relevant drugs within 30 days periods.

Performing 18 echocardiographic measurements, each taking about 30 minutes, would take a highly experienced 3D echocardiography specialist a total of 9 hours of work. This amount of time reflects the technical complexity of imaging the right heart, which is much more challenging than the left heart due to its anatomical position and orientation. Furthermore, unlike CorLog, these echocardiographic examinations cannot be automated. CorLog enables continuous, automated analysis of PBEF and provides data with high temporal resolution without the need for repeated, resource-intensive imaging sessions.

The key clinical benefit for drug titration in this PAH patient is the efficiency and continuity of CorLog monitoring. After therapeutic adjustments, such as PAH-specific medications, expensive imaging equipment and specialized personnel are no longer required to assess treatment response. At the same time, the likelihood of re-admission to hospital can be kept low – not by repeated 3D echocardiography, but by the more cost-effective and equally informative CorLog monitoring.

Even if the cost of CorLog use were only reimbursed at the level of a standard right heart catheterization (approximately 5,000 US$), there would still be an important economic argument in favor of CorLog. Specifically, CorLog monitoring is associated with a 30% lower likelihood of incurring additional costs, such as those associated with clinical deterioration or re-admission, which can reach up to 40,000 US$ per case.

From the hospital’s perspective, the adoption of CorLog for 24/7 continuous mobile right heart monitoring may appear to be a financial loss when comparing the CorLog sales price to the 5,000 US$ reimbursement for Swan-Ganz catheterization. However, this perceived shortfall is offset by the potential cost avoidance: A 30% probability of avoiding 40,000 US$ in expenses equates to a statistically weighted cost savings of 12,000 US$ per patient.

In summary, CorLog is already cost-effective under current reimbursement terms, and its value is expected to increase further with procedure-specific reimbursement pathways. Beyond the economic considerations, CorLog provides better monitoring capabilities for patients with right heart failure, enabling more precise treatment adjustments and leading to better clinical outcomes.

[1] Mihai Gheorghiade, Muthiah Vaduganathan, Gregg C. Fonarow, Robert O. Bonow, 2013, January. Rehospitalization for Heart Failure: Problems and Perspectives. In Journal of the American College of Cardiology (pp. 391-403), https://doi.org/10.1016/j.jacc.2012.09.038
[2] Diamond J, DeVore AD. 2022, September. New Strategies to Prevent Rehospitalizations for Heart Failure. In Curr Treat Options Cardiovasc Med. (pp. 199-212), https://doi.org/10.1007/s11936-022-00969-y
[3] Pyi Phyo Aung, Kyeeun Park, Htoo Myat Nge, 2023, April. 30-day Readmissions After Left Ventricular Assist Device Implantation. In Journal of Cardiac Failure (pp. 607-608), https://doi.org/10.1016/j.cardfail.2022.10.152
[4] Bhattacharya PT, Hameed AMA, Bhattacharya ST, Chirinos JA, Hwang WT, Birati EY, Menachem JN, Chatterjee S, Giri JS, Kawut SM, Kimmel SE, Mazurek JA. 2020, November. Risk factors for 30-day readmission in adults hospitalized for pulmonary hypertension. In Pulm Circ. doi: 10.1177/2045894020966889
[5] Jacqueline Baras Shreibati, Jeremy D. Goldhaber-Fiebert, Dipanjan Banerjee, Douglas K. Owens, Mark A. Hlatky, 2017 February. Cost-Effectiveness of Left Ventricular Assist Devices in Ambulatory Patients With Advanced Heart Failure. In JACC: Heart Failure, (pp. 110-119), https://doi.org/10.1016/j.jchf.2016.09.008
[6] https://emka-medical.de/clinical-evidence/ Stand: 19.05.2025
[7] The ESCAPE Investigators and ESCAPE Study Coordinators. 2005, October. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness. In JAMA pp(1625-1633), https://doi.org/10.1001/jama.294.13.1625

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