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This article was written by Samer S. Najjar, MD.
Exciting new research examines continuous monitoring of skin lactate levels, which could offer a window for early intervention before heart failure requires rehospitalization.
Heart failure is a persistent public health challenge. Despite advances in treatment, more than 6 million people in the U.S. live with heart failure, including about 1 in 5 people over age 75. The American Heart Association predicts that total direct costs of heart failure will top $70 billion by 2030.
Led by principal investigator Farooq Sheikh, MD, MedStar Health Research Institute is conducting a new study to evaluate a device that could revolutionize heart failure monitoring, enabling cardiologists to intervene early and prevent worsening symptoms.
If cardiologists could step in before heart failure escalates, we could have a chance to reduce the emotional and financial burdens of repeat hospital admissions. Heart failure is a leading cause of hospitalization for patients over age 65, and patients have a 20% chance of being admitted again within 30 days.
Through the SENSA-HF study, we will investigate how simple, non-invasive technology could enable early detection of a rise in lactate, a biomarker of heart failure, restoring patients’ precious time and reducing costs for families and the health system.
Exploring a new way to monitor lactate.
SENSA-HF is a first-in-human trial of a revolutionary continuous lactate monitoring (CLM) system developed by Abbott. This feasibility study is designed to help us understand whether this device could work as an early warning system for worsening heart failure.
The device is based on technology already used to measure glucose at home in patients with diabetes, marketed as the FreeStyle Libre continuous glucose monitoring system. This small sensor, which sticks to the back of the arm, measures glucose in the fluid just under the skin.
Our primary focus in this small, early study is to gather initial data on whether this device and concept can detect lactate. We want to learn whether these sensors can accurately measure levels in interstitial fluid and provide an accurate picture of what’s happening inside the body.
MedStar Health patients who are hospitalized with acute decompensated heart failure who meet specific criteria will be invited to participate in the study. Participants must be adults over the age of 18 who:
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Have been hospitalized due to acute decompensated heart failure
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Have a left ventricular ejection fraction ≤40%
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Are willing to wear sensors and keep the associated smartphone app close to their body for the duration of the study
Our team will apply these sensors to the back of the arm to continuously monitor lactate levels. We will check participants’ blood lactate levels twice using sensor readings. This will tell us whether the sensors can accurately measure lactate, potentially opening a window for early treatment.
Related: Read “Leveraging the Autonomic Nervous System to Give Patients with Heart Failure a New Option.”
Lactate: A heart failure warning signal.
The heart muscle pumps oxygen-rich blood to the rest of the body. During heart failure, the heart muscle weakens, and the heart’s pump begins to fail. When the heart isn’t pumping properly:
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Fluid backs up into the lungs (called pulmonary edema), causing shortness of breath, and in other areas, leading to swelling in the abdomen or legs
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Blood flow slows down, so organs can’t get enough blood or oxygen (perfusion)
When the body’s tissues are oxygen-starved, they’re forced to use a different, less efficient energy source. Lactate is produced because of this process.
Rising lactate levels mean the body is in trouble. Hyperlactatemia, or elevated lactate, indicates that the organs aren’t getting enough oxygen from the blood. It’s consistently linked to poor health outcomes and can suggest a patient is on the way to a life-threatening event, such as cardiogenic shock.
A new way to intervene earlier.
Currently, lactate can only be measured in the blood after someone is hospitalized. By the time we can measure the amount of lactate in a patient’s blood in the hospital, worsening heart failure (decompensation) is already underway.
Patients with heart failure can sometimes get caught in a dangerous loop: As their condition gets worse, fluid backs up in their organs, including the stomach. This prevents them from properly absorbing medications intended to manage heart failure, making treatment less effective and heart failure worse.
Our research can help us understand whether this new CLM system could enable cardiologists to intervene when the vicious cycle begins. If effective, it could provide several advantages:
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Continuous monitoring: The device remotely monitors a patient’s lactate levels at home.
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Early alert and intervention: If lactate levels begin to rise, the physician could be alerted before the patient develops symptoms. The cardiologist could then adjust the patient’s heart failure medications to manage their condition better.
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Crisis aversion: Making early adjustments could reduce the need for heart failure-related emergency department visits or hospitalizations.
Related: Read “Research Evaluates Cinching Device to Relieve Symptoms of Heart Failure.”
Innovating for MedStar Health patients, and beyond.
At MedStar Health Research Institute, our clinician researchers continue to break new ground in heart failure care. We’re proud to partner with device manufacturers such as Abbott, who recognize our Advanced Heart Failure Program has the capacity and research expertise to test and advance these potentially revolutionary technologies.
What’s more, MedStar Health patients can participate in our clinical trials. Research such as SENSA-HF helps MedStar Health stay at the forefront of cardiovascular medicine, benefiting patients and providers today and long into the future.
