Easing the load on the heart

Aquapheresis, an innovative therapy that removes dangerous levels of excess fluid in patients suffer

Leonard Wohlfahrt, now 73, had no idea how sick he was a year ago.

A heart failure patient for about 10 years, Wohlfahrt normally did well on low-dose diuretics to get rid of excess fluid. Then last year, he suddenly became very ill.

“I had a lot of water buildup in my belly and my arms and legs, and I just couldn’t get rid of it,” said Wohlfahrt, who lives in Poughkeepsie with his wife, JoAnne. “The diuretics just weren’t helping anymore, but I didn’t realize how sick I was.”

Then Wohlfahrt’s daughter, Kristine Wohlfahrt, 43, brought her father to see Dr. Edward Philbin, medical director of the Heart Failure Program at Albany Medical Center.

“He told me I wasn’t going home, and that was that,” Wohlfahrt recalled. “There was so much fluid built up around the heart sac, I was in trouble and didn’t know it.”

That’s where a new option for heart failure called aquapheresis came in.

Ultrafiltration

According to Philbin, aquapheresis is an innovative therapy that removes dangerous levels of excess fluid in patients suffering from congestive heart failure.

The therapy has proven to be more effective in removing excess fluid than standard treatment and reduces the likelihood of repeated hospitalizations for congestive heart failure, said Philbin.

“The new research coming out and studies we are participating in would suggest that aquapheresis is more effective and safer than diuretics,” he added.

Aquapheresis is the first major advancement for acute fluid removal in the setting of acute heart failure since the introduction of diuretics more than 50 years ago.

Philbin explained that aquapheresis uses the process of ultrafiltration to remove excess sodium and water from the body. Blood is withdrawn through a catheter and circulated through the filter system that separates the fluids from the blood.

Once filtered, the clean blood is returned to the body through a second catheter.

By using the system, up to four liters of fluid can be removed in an eight-hour period with no significant impact on blood pressure, kidney function or electrolyte balance.

When Wohlfahrt was admitted to the hospital last July, he weighed 202 pounds. On discharge day, he weighed 158 pounds.

“I lost almost 50 pounds in five days said Wohlfahrt. “I joked that I haven’t weighed that little since basic training in the Army.”

Wohlfahrt said the process was painless.

“There were a couple of tubes stuck in my arm, and that was it,” he recalled. “You don’t really feel anything except the sensation that you are shrinking. Without question, it saved my life.”

Philbin said treatment for congestive heart failure using intravenous or oral diuretic drugs can cause decreases in blood pressure and levels of potassium or magnesium and may cause disruption of normal kidney function. Plus, diuretics can take a longer period of time than aquapheresis to be completely effective.

Overall, Philbin said aquapheresis removes more fluid, more rapidly, than standard treatment with diuretics alone.

“Having the option of aquapheresis is a tremendous development in the treatment of congestive heart failure, and although relatively new, it is a very attractive alternative that will change the way our patients live,” said Philbin.

Wohlfahrt’s daughter, a nurse practitioner in the pediatrics department at Albany Med, said although she was scared for her father at first, doctors and nurses quickly instilled confidence.

“I was actually much more at peace than ever before,” she said. “Every day, his skin got softer and softer, and the slowness of the process was very gentle on his body.”

Repeating may be needed

Aquapheresis requires the skill and expertise of the physicians, nurses and staff of the Heart Failure Program, said Philbin.

“Aquapheresis has minimal effect on patients’ blood pressure and heart rate because it’s so gradual,” explained Julie Suarez, clinical nurse specialist and nurse practitioner for cardiopulmonary surgery and heart transplant services.

Mary Ann Rifenberick, assistant nurse manager of the Heart Transplant Unit, said the process usually takes between one to three days with an average weight loss of between 35 and 40 pounds.

“It keeps the electrolytes stable, so the person’s potassium and sodium remain stable,” said Rifenberick.

After treatment, patients are also more responsive to diuretics.

“Unfortunately, because heart failure is a chronic disease and tends to be progressive, some people may need to eventually return, but improvements usually last for several months,” said Suarez. “If a person has a good response, you could repeat this every several months. This may be something that really improves the quality of their lives.”

So far, aquapheresis has been used on 15 patients of varying ages with good response.

“Heart failure is the number one cause of hospital admissions in people over 65,” said Philbin. “We think it’s important for hospitals to have this alternative.”

So far, Wohlfahrt has only had to have aquapheresis one time.

“But it’s certainly comforting to know it’s there, if we do need it again,” said his wife.

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