Newswise — When the heart becomes weak and pumps inefficiently, the condition is called heart failure. It doesn't mean the heart has stopped, but that it is not circulating blood as well as it should. Causes include chronic high blood pressure, damaged heart muscle, and heart attacks.
Heart failure is the No.1 reason for hospital admissions of people over age 65. With the aging of the American population, it's estimated that heart failure cases will double, from 5 million to 10 million, in the next 15 years.
For patients in various stages of heart failure, physicians can offer a range of therapies based on developments in medical cardiology, interventional cardiology, electrophysiology, and surgery.
"Treating heart failure has become a robust clinical specialty," said Dr. Daniel Fishbein, University of Washington (UW) associate professor of medicine, Division of Cardiology, "in part because medical science has made many advances in understanding what happens to the heart as it weakens."
Tailoring care to each patient's form of heart failure means identifying the underlying problem and designing a therapeutic approach to reduce symptoms, improve heart function, and prolong life.
A model for survival
A University of Washington-developed model accurately estimates one-, two-, and three-year survival rates and average years of survival for people with heart failure. The model incorporates heart-failure medications and devices and demonstrates how therapy affects survival. Dr. Wayne Levy, UW associate professor of medicine, Division of Cardiology, created the Seattle Heart Failure Model.
"We're trying to encourage patients and physicians to use the medications and devices that we know will work in heart failure patients," Levy said. Heart-failure medications, for example, are effective and relatively inexpensive, because many come in generic form. However, in one analysis of data on hospitalized patients from the ADHERE (Acute Decompensated Heart Failure National Registry), only 41 percent were taking an ACE inhibitor and only 45 percent were on beta blockers
"The question we're asking is: Why aren't they on these proven life-saving heart failure medications?" Levy said. "The Seattle Heart Failure Model will actually illustrate why patients need to take them."
The model helps in deciding on the use of cardiac devices, such as biventricular pacemakers and implantable cardiovertor defibrillators, and in determining who should receive a heart transplant.
Significant treatment improvements
Fishbein said that one of the exciting things about heart failure treatment is that, in many cases, physicians are able to help patients have a significant improvement in heart function.
He told about a middle-aged patient whose heart was severely damaged from an unknown cause. The patient was being considered for heart transplantation. The patient's heart failure was difficult to treat until physicians installed a cardiac resynchronization device in the patient's basketball-shaped heart. The patient's blood pressure improved, and the patient was better able to tolerate heart-failure medications.
"The heart is now shaped normally and the heart function has returned to normal," his physician said. "The patient has gone back to work and has been taken off the transplant list."
The device has been shown to improve symptoms in 70 percent of patients and to reduce their risk of death by a large margin.
Devices that pump blood
For patients whose hearts don't respond to simpler therapies, there are more invasive treatments such as left ventricular assist devices. These small, implanted machines take over the function of the heart in end-stage heart failure, said Dr. Ed Verrier, UW professor of surgery and chief of cardiac surgery.
They are used during recovery after a heart injury; as a bridge to a heart transplant; and for patients who are not heart transplant candidates.
Surgery done on organs via needle punctures of the skin, rather than through a scalpel incision that exposes the organ, is making treatments easier on heart patients. These are called percutanous procedures. Percutaneous ventricular assist devices, for example, are not implanted into the chest, but instead are routed into the heart through blood vessels in the leg. These devices can support patients during high-risk coronary interventions or during recovery from a major heart attack.
Stenting an artery
Interventional cardiologists like Dr. Larry Dean, UW professor of medicine, Division of Cardiology, and director of the UW Regional Heart Center, have seen their efforts enhanced by the introduction of drug-coated stents. These tiny tubes are inserted to hold open previously blocked major arteries, and help prevent clogging. Biodegradable stents may be available in the future.
Irregular heart beats
In some people the opening and the closing of heart valves has gotten out of sync.About 1 in 20 adults older than age 65 have the most common arrhythmia, atrial fibrillation. Chronic atrial fibrillation can contribute to heart failure, said Dr. Richard Page,UW professor of medicine and head, Division of Cardiology.
Treatments include medications and, in some cases, radio-frequency ablation, which corrects the electrical abnormality by destroying a tiny spot of tissue. Regardless of the cause of heart failure, an implantable defibrillator often can prevent potentially fatal arrhythmias.
Facts on University of WashingtonHeart Transplants
In November 2005, UW Medical Center marked the 20th anniversary of its heart transplant program. The program has one of the highest survival rates in the country. Some 70 percent of patients are living 10 years after transplant surgery.
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