The recently opened Advanced Cardiac Therapies (ACT) Unit at Brigham and Women’s Hospital (BWH) represents a new way of delivering care to patients with heart failure. The ACT Unit offers complex monitoring, multidisciplinary expertise, and conventional and innovative therapies in a patient-centered environment. The 15-bed ACT Unit is a specialized service of the Cardiovascular Center at Brigham and Women’s Hospital.
Kenneth L. Baughman, MD, Director of the Advanced Heart Disease Program at Brigham and Women’s Hospital says, “Our purpose in the ACT Unit is to better understand each patient’s disease, to treat the acute manifestations of heart disease, and to establish an effective therapeutic regimen that can be maintained as much as possible on an outpatient basis.”
Patients who will benefit most from care in the ACT include:
Patients who may benefit from so-called “tailored therapy.” Patients with refractory heart disease who are not responding to oral medications are monitored with Swan-Ganz technology to get information about their individual hemodynamics and the specific abnormality causing their disease. Physicians establish new medication regimens known to be effective against those abnormalities, monitor effectiveness, and titrate medications as needed. Once the patient’s disease is under control, physicians convert the patient to oral therapy.
Candidates for ultrafiltration therapy. Patients with refractory heart disease, poor kidney function, and fluid overload may benefit from treatment with an innovative ultrafiltration device that can mechanically remove up to 500 cc of fluid per hour through small cannulae placed in peripheral veins. The device is used over a period of one to several days to re-establish volume control, after which patients generally can be managed with standard therapy.
Patients being evaluated for or recovering from major interventions, including high-risk revascularization or valve surgery, ventricular remodeling, biventricular pacing therapy, ventricular assist device (VAD) insertion, or cardiac transplant.
Patients who may benefit from investigational protocols. There are at any time between 12 and 15 open trials of new medications, devices, and monitoring systems that may benefit appropriately selected patients. Two of the most promising are the UNLOAD trial, comparing outcomes of patients treated with the new ultrafiltration device to those of patients receiving standard therapy, and the FUSION trial of the effectiveness of weekly outpatient infusion of nesiritide for high-risk patients.
Multidisciplinary cardiology expertise
Physicians in the Advanced Heart Disease Program collaborate closely with their colleagues in electrophysiology, catheter-based interventions, and cardiac surgery to provide comprehensive care for each patient.
Specially trained nurses who have experience with Swan-Ganz therapies, ventricular assist devices, and the ultrafiltration device round out the care team. The team meets weekly to discuss each patient’s progress and make modifications to their care, if necessary. Physicians in the ACT Unit work closely with referring physicians to maintain continuity of care.
Prolong life, improve quality-of-life
Dr. Baughman says, “The ACT Unit is a place of hope. Advanced heart disease, once considered a terminal condition, can today often be managed as a chronic illness. It is our goal not only to prolong life, but also to improve the quality of life for advanced heart disease patients.”
This article appeared in BWH's March 2005 Cardiovascular Center Update.
The Cardiovascular Center at BWH
Delivering innovative insights and solutions to even the most complex disorders of the heart, vessels and circulatory system, The Cardiovascular Center leads the way in providing comprehensive care across the full spectrum of cardiovascular disease areas. Many of the innovative therapies and state-of-the-art technologies available at the Center have been developed by the experts of Brigham and Women’s Hospital. We are consistently ranked among the best hospitals in the country in just about every specialty, including cardiac surgery, cardiovascular medicine and vascular surgery.
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