Harold Houston used to worry every night about going to sleep. At age 67, he was diagnosed with congestive heart failure, and among his many symptoms was sleeplessness. “I was miserable,” recalled Harold. “I was short of breath, my legs were painful, and I was having difficulty with simple things like getting in and out of the car. Then at night when I would try to sleep, I was afraid that my heart would stop beating. I would wake up gasping for air.”
Like many heart failure patients, Harold had tried medications for a few years, but he was not seeing noticeable improvement. He also had a prior atrial fibrillation (AFib) ablation to treat irregular heartbeats. At age 70, a visit to his cardiologist revealed an ejection fraction (EF) rate around 30%. EF is a measurement of how much blood the heart pumps out with each contraction and is normally between 55 and 65%.
MedStar Washington Hospital Center was just launching a new FDA-approved treatment for heart failure, called Barostim™ (Baroreflex Activation Therapy), when Harold began researching what else could be done to manage his symptoms and improve his day-to-day life. “I came across Barostim and saw that MedStar Washington was an option right here, close to Maryland. It was a bit of a drive from the Eastern Shore, but I wanted to see if it could be a good fit for me,” he said.
“Barostim is not for every heart failure patient, but for the right patients, it can make a major difference in their lives,” shared Dr. Richa Gupta, specialist in advanced heart failure and transplant cardiology at MedStar Washington. “Oftentimes, heart failure patients being treated with medications can still have difficulty performing meaningful daily activities due to their symptoms, such as showering, cooking, and climbing stairs. If a patient is being treated for heart failure and still not feeling well, we should explore why that is.”
How it Works
Barostim is an implantable device designed to restore balance to the autonomic nervous system (which controls vital body functions such as breathing, digestion and heart rate) and reduce symptoms of systolic heart failure. “The procedure itself is akin to getting a pacemaker placed, with a similar recovery time,” shared Dr. Gupta. “Patients typically go home the same day.”
Electrical impulses from the device are directed to baroreceptors located in the wall of the carotid artery. When activated, signals are sent from the baroreceptors through the neural pathways to the brain which responds by prompting the arteries to relax, the heart to slow down, and reduce the heart’s workload, targeting the same pathways that heart failure medications target to block the maladaptive stress pathways that worsen heart failure and fluid retention.
Harold’s procedure was scheduled for just after Christmas 2024. “I was looking forward to it. It didn’t matter to me that the hospital was a few hours from my house because I had confidence in the team at MedStar Washington and my wife Joanette made it all possible by being such a supportive caregiver,” recalled Harold. “Everything went smoothly, and my EF was back up to the 55-60% range. I felt relief right away.”
Harold was able to have follow-up appointments for titration of the device with his cardiologist whose office is much closer to his home. “Before I even went for my first follow-up, I could tell a great deal of difference. I sleep better, I can get in and out of the car, and I’m no longer constantly worried that my heart will stop,” shared Harold. “The doctor told me everything looked great, and I was already feeling like a new man!”>
A clinical engineer from Barostim joins Harold for his appointments with his local cardiologist to ensure that the titration – or strength of the impulse – is adjusted to the right level for him. “Once the device is titrated, which usually takes 2-3 months, he’s good as long as he’s not having any issues. It’s like ‘set it and forget it’, unlike pills that you have to remember to actively take each day—though those pills/heart failure medications are still very important to take even after Barostim has been implanted,” said Dr. Gupta “The average battery life is 6 years with no charging required, and during that time it’s always on and working.”
A Window of Opportunity
Barostim could offer the symptom relief that heart failure patients are looking for if they are a good fit. Currently, Barostim is FDA approved for patients with heart failure and a left ventricular ejection fraction of 35% or lower. Moreover, “there is a golden window of opportunity for Barostim where patients seem to have good response to the therapy. In general terms, that window is after a heart failure patient starts guideline-directed medications, but before they are considered too sick,” explained Dr. Gupta. “When their heart failure medications are not enough to relieve heart failure symptoms like fatigue, exercise intolerance, and low quality of life, or to prevent heart failure hospitalizations - but before they are considered ‘end stage’ and might need a more invasive treatment like Left Ventricular Assist Device (LVAD) or heart transplant surgery to improve their survival rate - they’re in the window.” With 6.7 million adults 20 and older in the United States diagnosed with heart failure, many heart failure patients do fall in this window and are good candidates. If there is any doubt, the earlier that patients can be evaluated for the device in the course of their heart failure disease process, the better.
“In 2024, more than 10,000 patient visits were conducted for heart failure at MedStar Washington by the advanced heart failure program, and heart failure still remains undertreated in this region. The prevalence of heart failure is only increasing as we have more and more tools for treatment to help patients live longer, and the demand for Barostim is only going to increase,” said Dr. Gupta. “More and more patients are living with their heart failure at various stages well into later decades of life. Between the time that patients are started on medical therapy after an initial heart failure diagnosis and the time that patients progress to the end stages of heart failure -for which only heart transplant and left ventricular device surgeries can improve survival - there is a window of opportunity in which device therapy can be used to make patients’ lives better and potentially delay disease progression.”
Rest, Relief, and More Energy
Harold now recommends the procedure to others because it’s made such a difference for him, “I don’t wake up in the middle of the night gasping for air and I have more energy to enjoy my life again. The swelling in my extremities has gone down almost completely and the fluid around my heart is gone. It was such a blessing, and I couldn’t be happier. I’ve talked to quite a few people about it who are in a similar situation and encourage them to get in contact if they want to live. I believe in this so much from my own experience and I have nothing but admiration for the care team at MedStar Washington.”
While it is not possible to definitively conclude that the device itself improved Harold’s ejection fraction, Dr. Gupta considers Harold’s improvement in quality of life and exercise capacity to be typical, based on outcomes reported from clinical trial participants prior to the device receiving FDA approval, as well as outcomes she has reviewed since MedStar Washington started its program. “Clinical trial participants reported feeling improvements in sleeping, shortness of breath, fatigue, depression, and even doing things with friends and family,” shared Dr. Gupta. “They also had a 74% reduced risk in receiving additional heart failure treatments, including LVAD and heart transplant, and fewer hospitalizations.”
MedStar Washington launched its program in January 2023, and close to 30 patients have been implanted with Barostim so far. “We work with cardiologists throughout the region – it’s as easy as a single consultation,” shared Dr. Gupta. “The win-win of this procedure is that it’s low-risk, easy recovery, and produces results. Roughly 90% of our implanted patients reported seeing improvements in their heart failure symptoms. Heart failure medications have survival benefits but don’t give you much quality-of-life improvement. That’s where Barostim can fit in and fill an important gap.”