Inova Introduces Standardized Protocol to Improve Outcomes for Heart Failure Patients with Leaky Mitral Valves
Inova Heart and Vascular Institute (IHVI) is working to improve treatment for patients who have mitral regurgitation related to heart failure by using a standardized protocol that marries the expertise of its advanced heart failure team with the structural heart team. The protocol prompts proven best practices in the use of medication and improves access to the MitraClip™ procedure to repair a leaky mitral valve. Key to its success is the role of advanced practice providers (APPs), who have been an integral part of the IHVI team for more than four decades.
The mitral valve is located between the atrium (upper chamber) and ventricle (lower chamber) on the left side of the heart. When the valve doesn’t close properly, blood can leak back into the left atrium – a problem known as mitral regurgitation. Some patients develop heart failure because of mitral regurgitation. The MitraClip procedure, which is minimally invasive, is the only non-surgical procedure to repair leaky mitral valves. It is indicated for patients who continue to have severe symptoms despite being on medication.
“We created a protocol called the Inova Heart Failure Treatment Algorithm as a way to assure the most comprehensive care for these patients. We first make sure they receive the full benefit of medication therapy to address the leaky valve. For those who need care beyond that, we evaluate to determine whether they are good candidates for the MitraClip procedure,” said Kathleen Emper, FNP, one of eight APPs on Inova’s advanced heart failure team. “We work as a bridge between the heart failure and structural heart teams to identify patients who could benefit from this protocol, so they can live longer and have a better quality of life by using the MitraClip device.”
The protocol was developed for patients with symptomatic heart failure due to reduced ejection fraction (a measurement of how well the heart is pumping blood) and moderate to severe mitral regurgitation. “Our goal was to emulate some earlier research in a clinical trial, which showed that use of the MitraClip, in addition to medication, was safe, reduced the severity of mitral regurgitation and resulted in an improved prognosis compared with medication alone,” said Matthew Sherwood, MD, MHS, Co-Director of IHVI’s Structural Heart Program.
“Inova wants to lead the charge across the nation to make this a standardized practice,” according to Wayne Batchelor, MD, MHS, FACC, FSCAI, System Director of IHVI’s Interventional Heart Program. “We set out to determine if we can improve outcomes and quality of life, and we are already seeing great results.”
Patients referred by their cardiologists are evaluated by a heart failure APP and go through a “boot camp” that educates them about their disease, including exercise and nutrition, in addition to receiving medication in the highest doses they can tolerate. “We are one of the few places in the country that has created and implemented this process using APPs,” noted Carolyn Rosner, NP, Director of Innovative Programs for IHVI.
Once the advanced heart failure team determines that the medications have been optimized, a structural heart specialist reevaluates imaging of the patient’s valve to determine if the patient is a good candidate for the MitraClip repair.
After the MitraClip procedure, patients return to their original cardiologist for ongoing monitoring. “In some cases, their valvular disease has improved so much with the medication alone that they no longer need the MitraClip device,” said Dr. Sherwood. “However, the majority do need it, and we recommend the patient move forward with the procedure. Based on the results to date, we now have confidence these patients will see major benefits in quality of life and reduced mortality and morbidity.”
Inova’s Structural Heart/Valve Disease Program focuses on improving survival and quality of life for people with disease affecting the heart’s internal structures. They are leaders in minimally invasive heart valve repair and surgery.