A new therapy to help heart failure patients with water retention has been introduced for the first time in Asia, by National Heart Centre Singapore (NHCS). Called Aquapheresis, it is a form of ultra-filtration that removes excess salt and water from the body. The therapy is targeted at those who have a resistance to diuretics, or medication that helps the body get rid of excess fluid through the urine.
It’s hard to imagine that just a few weeks ago, Mr Soh Teow Cheng was 15.5kg heavier. The 69-year-old taxi driver had trouble doing simple activities. “I walk hardly more than 10 metres, and I’m breathless,” said Mr Soh. Doctors said swelling in his leg and abdomen showed he was severely overloaded with fluid – a result of heart failure. As Mr Soh was not responding well to high doses of diuretic treatment, he underwent Aquapheresis therapy. After five days of being hooked up to a machine, he was not only physically lighter, but more active. “No more breathlessness, and not as bad as what it used to be. I can walk very far now,” said Mr Soh. During treatment, blood is withdrawn from the body through catheters inserted in the patient’s veins. Excess fluid from the blood is filtered out and collected in a bag. The filtrated blood is then re-circulated into the body. The duration of the treatment depends on how severe the patient’s condition is, but can be up to 72 hours. Once the patient’s weight loss target is achieved, diuretic treatment can begin again. NHCS’s consultant in the Department of Cardiology, Dr David Sim, said: “When they are acutely overloaded, the patient may have diuretic resistance. “But once you manage to bring them back to their usual weight, the diuretic resistance is only for a certain period of time. “It’s quite unusual for a patient to have diuretic resistance persistently.” So far, six patients have received Aquapheresis therapy at NHCS. The centre estimates that about 50 of its patients will benefit from Aquapheresis therapy a year.
This new therapy is believed to shorten the length of a patient’s stay in hospital. It’s also seen as reducing readmissions and preventing unscheduled visits to the emergency department or clinic. That’s because fluid overload accounts for over 90 per cent of heart failure hospitalisations. In the future, the centre hopes to roll out an outpatient programme for this treatment. Locally, there are about 5,000 cases of heart failure admission a year. The NHCS sees 1,000 of these cases each year.