Posted by: Duke Raleigh Hospital | July 8, 2020

International Coordination Leads to First for Duke Health

Dr. Kishan Parikh, Silvia Macagno and her husband in early 2020 (before COVID-19).

In December 2019, a patient visiting Duke from Argentina underwent a CardioMEMS implantation at Duke Raleigh Hospital. Silvia Macagno, who has a longstanding history of heart failure, pulmonary hypertension and multiple heart surgeries, is Duke University Health System’s first patient to receive the device for clinical use with international remote monitoring.

 “Doctors first discovered a malformation of my heart at my first physical exam in school, when I was six years old,” Macagno remembered.

Macagno was connected with Duke Raleigh Hospital for care through Dr. Alex Barbagelata, an adjunct professor in Duke’s Department of Medicine, who practices in Argentina.

“When I first saw Macagno she had already had four surgeries,” said Dr. Barbagelata. “Her heart was weakening and her pulmonary pressure was increasing.”

Macagno traveled to North Carolina to be assessed for potential advanced heart failure therapies. Once here, though, her care team decided on pulmonary hypertension care, including the implantation of the CardioMEMS.

Dr. Kishan Parikh a Pulmonary Hypertension/Advanced Heart Failure Specialist with Duke Health, lead implantation of the CardioMEMS device. The device is implanted into the pulmonary artery to measure lung pressures from the patient’s home. This allowed Dr. Parikh to more closely manage Macagno’s heart failure and pulmonary hypertension.

“Fluctuations in these pressures can predict clinical changes. If we can act on this data, we can reduce heart failure complications,” said Dr. Parikh. “The information provided by the CardioMEMS device is like having data from a right heart catheterization procedure daily.”

The data from Macagno’s device is transmitted to an online portal where Dr. Parikh monitors the readings, allowing him to work with Dr. Barbagelata to manage Macagno’s condition from Raleigh while she is at home in Argentina.

“This device helps bring care delivery from inside the hospital and clinic, to the patient’s home,” added Dr. Parikh. “It allows us to see trends, instead of just a snapshot every couple of months, so we can be proactive instead of reactive in our care of Ms. Macagno.”

Dr. Barbagelata sees Macagno as a model for future patients. “You can be 5,000 miles away and access data on your cell phone and decide the patient needs a change in their care or treatment,” Dr. Barbagelata said. “This new collaboration for the well-being of the patient is exciting and fascinating.”

Typically, this implantation is an outpatient procedure but, due to other complications, Macagno spent five weeks receiving care at both Duke Raleigh Hospital and Duke University Hospital.

“If we weren’t in North Carolina, I might not be alive,” said Macagno.

Dr. James Mills, interventional cardiologist, performed the CardioMEMS implantation. Much of the cost of the necessary procedures was covered through donations. Dr. Sean Pokorney, MBA donated his time to implant a cardiac resynchronization therapy defibrillator, which was also donated. This implantation was performed at the same time as the CardioMEMS to avoid multiple procedures. The anesthesia team also donated their time for the procedure.

“In Argentina, we have very good insurance, but it doesn’t work here,” said Daniel Macagno, Silvia’s husband. “We have had to go through many steps to get here and to pay for treatment here in the United States. This means a lot.”

Members of the team that performed Macagno’s procedure in December 2019 (before COVID-19).

For Macagno, this procedure could mean fewer hospitalizations as symptoms, and new treatment strategies will now be monitored in real time.

“This has really taken a lot of coordination and teamwork,” said Dr. Parikh. “And I really appreciate Duke Raleigh Hospital leadership for their support, Abbie Faircloth in planning and organizing the care, and Duke Raleigh Heart Failure Clinical Nurse Specialist Amelia Ross for helping with the coordination of care between here and Argentina for Silvia.”

For Dr. Parikh, of the Duke Raleigh Hospital team, the hope is that this procedure leads to big improvements in Macagno’s quality of life. He hopes “this procedure leads to improving heart failure care for more patients at Duke Raleigh Hospital and strengthens our partnership with Dr. Barbagelata and his patients in Argentina.”

–By Stephen McNulty

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