U-M Cardiovascular Center lays groundwork to distribute used pacemakers in needy nations

ANN ARBOR, Mich. - Recycling could make its mark in medicine by giving millions of Americans the chance to donate an unexpected resource: the tiny pacemakers that help regulate their heartbeat.

Experts at the University of Michigan Cardiovascular Center see an opportunity to collect pacemakers, after they are removed for burial or cremation, for sterilization and reuse across the globe. It's a novel approach for treating cardiovascular disease, the world's leading cause of death.

U-M survey results presented Thursday at the Heart Rhythm Society's Annual Scientific Sessions show that if given the choice, 87 percent of those with pacemakers and 71 percent of the general population would be willing to donate a device to patients in underserved nations.

Funeral directors also strongly support such an effort. In a U-M survey of 100 Michigan funeral directors, 84 percent said pacemakers were routinely discarded or stored with no purpose, and 89 percent of directors were willing to donate them for charitable use.

The surveys provide the groundwork for Project My Heart -Your Heart, a collaborative between citizens, physicians and funeral directors of Michigan, the U-M Cardiovascular Center and World Medical Relief, Inc., a Detroit-based non-profit organization that specializes in the delivery of used medical equipment, and through inaugural fund support from the U-M Cardiovascular Center.

"Undoubtedly, pacemaker reuse can safely and effectively transform a currently wasted resource into an opportunity for a new life," says Timir Baman, M.D., senior author of the report and a cardiology fellow at the U-M Cardiovascular Center.

Poor nations have not been able to afford the electrophysiology technology that has reduced cardiac deaths in industrialized nations, while unhealthy lifestyle, as well as infectious diseases, contribute to escalating rates of heart disease worldwide.

After families consent, donated devices will be sent to the U-M for assessment of battery longevity. If the device has a battery life greater than 70 percent, it will be sterilized and old patient information will be erased, with the ultimate goal of allocating devices to institutions throughout the world with assistance from WMR.

"The beauty of this intervention is that you can take someone who's completely debilitated and unable to have a job, implant the device and they can return to being a functioning member of society," Baman says. "This is a very fixable problem."

Pacemakers and other implantable cardiac devices are implanted to regulate an irregular or slow heartbeat, or act as an insurance policy by automatically shocking the heart back to a normal rhythm. They are usually implanted after a heart attack or if medications are unsuccessful, and they last 10-15 years.

In recent decades, industrialized nations have seen a drop in deaths from heart attacks and strokes, but those in low- and middle-income nations continue to experience an epidemic of cardiovascular disease. The health disparity is partly due to an economic gap. The $15,000 to $50,000 cost of pacemakers makes them unaffordable in many low- and middle-income countries, Baman says.

Baman hopes to dispel the perception that heart disease is mainly a problem for rich nations where people may be less active and more overweight - both risk factors for heart disease.

It's quite the contrary considering tobacco use is greater in Third World nations than in the United States, and infectious diseases that can affect heart rhythm persist abroad. For instance, in South America and Central America, the parasitic infection Chagas disease can disrupt connections in the heart.

"There is little data on how many people have heart disease conduction problems," Baman says. "There are reports of 1 million to 2 million dying annually, but we think this may underestimate the true burden of disease. We hope that by creating awareness surrounding this project we will have a better idea of how many are suffering from this kind of heart disease."

Through small humanitarian efforts, new and used pacemakers have been sent to underserved nations. Last year, 50 pacemakers were donated by funeral homes to WMR. Of them, 12 with adequate battery life were implanted without complications in patients at University of Philippines-Philippine General Hospital in Manila.

Currently, the U-M is exploring partnerships with the University of Philippines and Komfo Medical Center in Ghana, which is in the process of developing an arrhythmia therapy program, for allocation of used pacemakers. In June, Baman will visit hospitals in Vietnam to pursue a partnership in that country. The international hospitals will be reviewed for quality and clinical excellence.

In the next phase, the U-M Cardiovascular Center will seek approval from the U.S. Food and Drug Administration to embark on a large scale clinical trial to show that distribution of used pacemakers is safe and effective.

"If we can create a successful regional collaborative in the state of Michigan, with firm evidence that the program is safe and reaching the right patients with clear medical and financial need, then perhaps we can replicate the initiative in other states," says Kim Eagle, M.D., senior investigator of Project My Heart-Your Heart and director of the UM Cardiovascular Center.

University of Michigan Cardiovascular Center http://www.med.umich.edu/cvc/

Written by Shantell M. Kirkendoll