What is a Chronic Care Management (CCM) device?

Cardiac Contractility Modulation (CCM) Device: Definition and Clinical Applications

A Cardiac Contractility Modulation (CCM) device is an FDA-approved implantable device that delivers relatively high-voltage, long-duration electric signals to the right ventricular septal wall during the absolute myocardial refractory period to augment left ventricular contractile performance in patients with heart failure. 1

Key Characteristics and Mechanism

• CCM delivers electrical signals during the absolute refractory period of the cardiac cycle, unlike traditional pacemakers or defibrillators that stimulate during other parts of the cardiac cycle 1
• The device applies signals specifically to the right ventricular septal wall to enhance left ventricular contractility 1
• CCM is distinct from other cardiac devices like cardiac resynchronization therapy (CRT) in its timing and mechanism of action 1

FDA-Approved Indications

• CCM is approved for patients with NYHA class III heart failure 1
• The device is indicated for patients with left ventricular ejection fraction (LVEF) of 25% to 45% 1
• It is specifically approved for patients who are not candidates for cardiac resynchronization therapy (CRT) 1

Clinical Evidence

• Four randomized controlled trials have demonstrated benefits in exercise capacity and quality of life with CCM use 1
• Current evidence does not yet show benefits in mortality or hospitalization rates 1
• The device has been evaluated primarily in NYHA class III heart failure patients 1

Relationship to Chronic Care Models

While CCM in heart failure refers specifically to this cardiac device, it's worth noting that the abbreviation "CCM" is also used in other contexts in medicine:

• In chronic disease management, CCM often refers to the "Chronic Care Model," which is a framework for improving care of patients with chronic conditions 1
• The Chronic Care Model includes six core elements: delivery system design, self-management support, decision support, clinical information systems, community resources, and health systems 1
• This model has been shown to improve outcomes in various chronic conditions, though this is distinct from the cardiac device discussed above 1

Clinical Considerations for CCM Device Use

• Patient selection is critical - the device is specifically for those with moderate heart failure (NYHA class III) who fall within the specified ejection fraction range (25-45%) 1
• Patients must not be candidates for CRT to be eligible for CCM 1
• The primary benefits demonstrated thus far are improvements in quality of life and exercise capacity, not mortality reduction 1
• As with other implantable cardiac devices, potential complications include infection, lead dislodgement, and device malfunction 1

Comparison to Other Heart Failure Devices

• Unlike CRT, which aims to resynchronize ventricular contraction in patients with conduction delays, CCM works by enhancing contractility directly 1
• Unlike implantable cardioverter-defibrillators (ICDs) that treat arrhythmias, CCM targets contractile function 1
• CCM represents one of several device-based approaches to heart failure management, alongside CRT, ICDs, and baroreceptor stimulation devices 1